Healthcare Provider Details

I. General information

NPI: 1902974074
Provider Name (Legal Business Name): MICHAEL ERICH MOSSMANN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MICHAEL ERICH MOSSMANN DDS

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MAIN ST.
SOUTH LANCASTER MA
01561
US

IV. Provider business mailing address

PO BOX 1208
SOUTH LANCASTER MA
01561-1208
US

V. Phone/Fax

Practice location:
  • Phone: 978-368-8474
  • Fax:
Mailing address:
  • Phone: 978-368-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21269
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: