MEDICARE: DR.SONIA MOUSSA DDS .PC.

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	019024234	IL

General Provider Information

NPI Number	:	1720249907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR.SONIA MOUSSA DDS .PC.

Provider Business Mailing Address
First Line	:	4403 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5403
Country	:	US
Telephone Number	:	773-769-4585
Fax Number	:	773-769-4553

Provider Business Practice Location Address
First Line	:	4403 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5403
Country	:	US
Telephone Number	:	773-769-4585
Fax Number	:	773-769-4553

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SONIA W. MOUSSA
Credential	:	DDS
Telephone Number	:	773-769-4585

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/20/2008

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