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General NPI Number Information
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NPI Number | 1871568386
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Entity Type | Individual
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Provider Name | EDWARD MOITOSO DMD
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Gender | Male
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Dates
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Enumeration Date | 02/19/2006
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 3015 BOBCAT VILLAGE CENTER RD
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City | NORTH PORT
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State | FL
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Zip | 34288-8972
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Country | US
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Telephone | 941-429-6558
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Fax | 941-429-6559
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Provider Business Mailing Address
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Address Line | 3015 BOBCAT VILLAGE CENTER RD
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City | NORTH PORT
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State | FL
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Zip | 34288-8972
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Country | US
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Telephone | 941-429-6558
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Fax | 941-429-6559
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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 | DN16788
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License Number State | FL
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