Healthcare Provider Details

I. General information

NPI: 1275547762
Provider Name (Legal Business Name): GARY J MOSKOWITZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE WALLIS COURT
LEXINGTON MA
02421
US

IV. Provider business mailing address

75 POTTER POND
LEXINGTON MA
02421
US

V. Phone/Fax

Practice location:
  • Phone: 781-862-2625
  • Fax: 781-862-9169
Mailing address:
  • Phone: 781-861-8924
  • Fax: 781-862-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9227
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: