Provider Demographics
NPI:1033109186
Name:MOSES, PHILIP D (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:D
Last Name:MOSES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-1521
Mailing Address - Country:US
Mailing Address - Phone:337-474-2563
Mailing Address - Fax:337-474-9444
Practice Address - Street 1:631 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1521
Practice Address - Country:US
Practice Address - Phone:337-474-9057
Practice Address - Fax:337-474-9444
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA34421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry