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General NPI Number Information
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NPI Number | 1205906526
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Entity Type | Organization
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Legal Business Name | JAMES S MOSSOP DDS INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 1320 APPLE AVENUE STE 104
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City | HAYWARD
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State | CA
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Zip | 94541-1552
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Country | US
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Telephone | 510-582-9055
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Fax | 510-582-8147
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Provider Business Mailing Address
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Address Line | 1320 APPLE AVENUE STE 104
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City | HAYWARD
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State | CA
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Zip | 94541-1552
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Country | US
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Telephone | 510-582-9055
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Fax | 510-582-8147
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Authorized Official
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Title or Position | ORAL SURGEON
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Name | JAMES S MOSSOP
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Credential | DDS
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Telephone | 510-582-9055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | 33343
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License Number State | CA
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