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General NPI Number Information
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NPI Number | 1487605234
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Entity Type | Individual
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Provider Name | VICTORIA S MOSUR DDS
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Gender | Female
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Dates
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Enumeration Date | 05/15/2006
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Last Update Date | 07/06/2013
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Provider Practice Location Address
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Address Line | 496 EAST AVE
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City | LINCOLN
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State | CA
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Zip | 95648-2061
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Country | US
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Telephone | 916-645-3373
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Fax |
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Provider Business Mailing Address
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Address Line | 496 EAST AVE
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City | LINCOLN
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State | CA
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Zip | 95648-2061
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Country | US
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Telephone | 510-754-0986
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 57650
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License Number State | CA
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