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General NPI Number Information
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NPI Number | 1336349166
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Entity Type | Organization
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Legal Business Name | TINA P. MOSES, DMD, PC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/19/2007
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Provider Practice Location Address
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Address Line | 1240 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-1854
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Country | US
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Telephone | 706-863-6262
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Fax | 706-863-6465
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Provider Business Mailing Address
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Address Line | 1240 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-1854
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Country | US
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Telephone | 706-863-6262
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Fax | 706-863-6465
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TINA PERRY MOSES
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Credential | DMD
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Telephone | 706-863-6262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN012036
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License Number State | GA
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