MEDICARE: DR. NICHOLAS G MOSCA DDS

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	122300000X	Dentist	2501-89	MS
2	1223D0001X	Public Health Dentistry	P-175	LA

General Provider Information

NPI Number	:	1528249158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS G MOSCA DDS

Provider Business Mailing Address
First Line	:	1549 VERNA CT
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2813
Country	:	US
Telephone Number	:	601-853-3988
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 FLORIDA AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2715
Country	:	US
Telephone Number	:	504-941-8416
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2007
Last Update Date	:	06/01/2022

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