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General NPI Number Information
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NPI Number | 1205291119
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Entity Type | Organization
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Legal Business Name | JMMDDS PLLC
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 4203 MEDICAL PKWY
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City | AUSTIN
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State | TX
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Zip | 78756-3309
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Country | US
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Telephone | 512-371-7239
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 N LAMAR BLVD STE. 145
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City | AUSTIN
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State | TX
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Zip | 78756-3712
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Country | US
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Telephone | 512-459-5437
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Fax | 512-459-8342
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Authorized Official
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Title or Position | OWNER
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Name | JAMES MICHAEL MOOSSY
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Credential | D.D.S.
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Telephone | 512-459-5437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19487
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License Number State | TX
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