MEDICARE: EDWARD MOITOSO DMD

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	DN16788	FL

General Provider Information

NPI Number	:	1871568386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD MOITOSO DMD

Provider Business Mailing Address
First Line	:	3015 BOBCAT VILLAGE CENTER RD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8972
Country	:	US
Telephone Number	:	941-429-6558
Fax Number	:	941-429-6559

Provider Business Practice Location Address
First Line	:	3015 BOBCAT VILLAGE CENTER RD
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34288-8972
Country	:	US
Telephone Number	:	941-429-6558
Fax Number	:	941-429-6559

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

Provider Enumeration Date	:	02/19/2006
Last Update Date	:	10/10/2019

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