MEDICARE: DR. BRAD JUSTIN MOSELEY D.D.S

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	28040	TX

General Provider Information

NPI Number	:	1538403928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD JUSTIN MOSELEY D.D.S

Provider Business Mailing Address
First Line	:	9099 KATY FWY
Second Line	:	140
City	:	HOUSTON
State	:	TX
Zip	:	77024-1632
Country	:	US
Telephone Number	:	713-465-1860
Fax Number	:	281-768-7759

Provider Business Practice Location Address
First Line	:	9099 KATY FWY
Second Line	:	140
City	:	HOUSTON
State	:	TX
Zip	:	77024-1632
Country	:	US
Telephone Number	:	713-465-1860
Fax Number	:	281-768-7759

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

Provider Enumeration Date	:	11/26/2012
Last Update Date	:	11/26/2012

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