Healthcare Provider Details

I. General information

NPI: 1912357690
Provider Name (Legal Business Name): BARSHA MOKTAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 S GULPH ROAD #110
KING OF PRUSSIA PA
19406
US

IV. Provider business mailing address

1001 PIMLICO DR
EAST NORRITON PA
19403-3962
US

V. Phone/Fax

Practice location:
  • Phone: 610-337-2325
  • Fax:
Mailing address:
  • Phone: 484-636-4153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS040853
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: