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General NPI Number Information
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NPI Number | 1235713348
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Entity Type | Organization
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Legal Business Name | DANNY MOOSA DMD, LLC
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Dates
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Enumeration Date | 05/06/2021
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Last Update Date | 05/10/2021
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Provider Practice Location Address
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Address Line | 1080 POLARIS PKWY STE 220
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City | COLUMBUS
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State | OH
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Zip | 43240-6035
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Country | US
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Telephone | 614-854-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 POLARIS PKWY STE 220
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City | COLUMBUS
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State | OH
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Zip | 43240-6035
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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 DENTIST
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Name | DANNY MOOSA
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Credential | DMD
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Telephone | 724-777-1170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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