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General NPI Number Information
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NPI Number | 1215405469
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Entity Type | Organization
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Legal Business Name | MAXIM MOSSMAN DDS, PLLC
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Dates
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Enumeration Date | 11/06/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 909 S TYLER ST
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City | DALLAS
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State | TX
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Zip | 75208-6254
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Country | US
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Telephone | 972-362-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 909 S TYLER ST
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City | DALLAS
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State | TX
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Zip | 75208-6254
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER / D.D.S.
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Name | MAXMIM MOSSMAN
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Credential | D.D.S.
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Telephone | 972-362-2225
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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 |
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License Number State |
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