MEDICARE: PATRICK P MOSELEY FAMILY DENTISTRY

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	1223G0001X	General Practice Dentistry	2914	AR

General Provider Information

NPI Number	:	1306977053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK P MOSELEY FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:	305 NORTH SPRING STREET
City	:	FORDYCE
State	:	AR
Zip	:	71742-0640
Country	:	US
Telephone Number	:	870-352-5161
Fax Number	:	870-352-7510

Provider Business Practice Location Address
First Line	:	305 N SPRING ST
Second Line	:	BOX 640
City	:	FORDYCE
State	:	AR
Zip	:	71742-3317
Country	:	US
Telephone Number	:	870-352-5161
Fax Number	:	870-352-7510

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATRICK P MOSELEY JR.
Credential	:	DDS
Telephone Number	:	870-352-5161

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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