Healthcare Provider Details

I. General information

NPI: 1659457489
Provider Name (Legal Business Name): PHILIP MOSES JOSEPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PHILIP MOSES JOSEPH D. M. D.

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 ATRIUM WAY
COLUMBIA SC
29223-6301
US

IV. Provider business mailing address

116 ATRIUM WAY
COLUMBIA SC
29223-6301
US

V. Phone/Fax

Practice location:
  • Phone: 803-699-2600
  • Fax: 803-699-1731
Mailing address:
  • Phone: 803-699-2600
  • Fax: 803-699-1731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2185
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: