MEDICARE: BRIAN J. MOSES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215682117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN J. MOSES

Provider Business Mailing Address
First Line	:	5386 STATE RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-1244
Country	:	US
Telephone Number	:	216-661-2422
Fax Number	:	216-661-2837

Provider Business Practice Location Address
First Line	:	5386 STATE RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-1244
Country	:	US
Telephone Number	:	216-661-2422
Fax Number	:	216-661-2837

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LENA SALES
Credential	:
Telephone Number	:	216-661-2422

Provider Enumeration Date	:	02/18/2022
Last Update Date	:	02/18/2022

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Directions to “BRIAN J. MOSES ” Practice Location

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