Provider Demographics
NPI:1043349616
Name:MOSLEY-HOUSE, JOAN A (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:A
Last Name:MOSLEY-HOUSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5422
Mailing Address - Country:US
Mailing Address - Phone:507-388-2120
Mailing Address - Fax:
Practice Address - Street 1:7332 BRENTWOOD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2215
Practice Address - Country:US
Practice Address - Phone:215-473-5453
Practice Address - Fax:215-473-2363
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027135L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice