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General NPI Number Information
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NPI Number | 1306977053
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Entity Type | Organization
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Legal Business Name | PATRICK P MOSELEY FAMILY DENTISTRY
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 305 N SPRING ST BOX 640
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City | FORDYCE
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State | AR
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Zip | 71742-3317
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Country | US
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Telephone | 870-352-5161
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Fax | 870-352-7510
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Provider Business Mailing Address
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Address Line | PO BOX 640 305 NORTH SPRING STREET
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City | FORDYCE
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State | AR
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Zip | 71742-0640
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Country | US
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Telephone | 870-352-5161
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Fax | 870-352-7510
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICK P MOSELEY JR.
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Credential | DDS
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Telephone | 870-352-5161
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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 | 2914
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License Number State | AR
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