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General NPI Number Information
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NPI Number | 1952007197
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Entity Type | Organization
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Legal Business Name | MOSES FAMILY DENTISTRY, LLC
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 1776 N AIRLINE HWY STE B
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City | GONZALES
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State | LA
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Zip | 70737-2127
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Country | US
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Telephone | 225-369-0481
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Fax | 225-369-0482
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Provider Business Mailing Address
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Address Line | 1535 RIVER PARKWAY BLVD APT 1002
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City | SHREVEPORT
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State | LA
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Zip | 71104-1812
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Country | US
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Telephone | 913-602-0519
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRADLEY LEE MOSES
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Credential | DDS
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Telephone | 913-602-0519
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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