Healthcare Provider Details

I. General information

NPI: 1649203589
Provider Name (Legal Business Name): ALLISON ANN MOISE-HAMADA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 DICKORY AVE STE 200
HARAHAN LA
70123-8531
US

IV. Provider business mailing address

2020 DICKORY AVE STE 200
HARAHAN LA
70123-8531
US

V. Phone/Fax

Practice location:
  • Phone: 504-734-0434
  • Fax: 504-734-1496
Mailing address:
  • Phone: 504-734-0434
  • Fax: 504-734-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5262
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: