=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235355439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTT MOSBY DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2420 NORTHPARK DR
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-5103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-359-6672
-----------------------------------------------------
Fax | 281-359-3159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2420 NORTHPARK DR
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77339-5103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-359-6672
-----------------------------------------------------
Fax | 281-359-3159
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SCOTT JAMES MOSBY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 281-359-6672
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 14547
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------