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General NPI Number Information
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NPI Number | 1427435809
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Entity Type | Organization
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Legal Business Name | HAITHAM MOSLY, DMD, A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 1740 SANTA CLARA DR SUITE 100-B
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City | ROSEVILLE
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State | CA
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Zip | 95661-2921
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Country | US
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Telephone | 916-797-0406
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 SANTA CLARA DR SUITE 100-B
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City | ROSEVILLE
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State | CA
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Zip | 95661-2921
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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 | DMD/PRACTICE OWNER
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Name | HAITHAM MOSLY
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Credential |
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Telephone | 916-797-0406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61008
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License Number State | CA
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