Provider Demographics
NPI:1063462034
Name:MOSES, MARK A (DMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MOSES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SHENANGO RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1119
Mailing Address - Country:US
Mailing Address - Phone:724-656-1510
Mailing Address - Fax:724-656-4908
Practice Address - Street 1:11 SHENANGO RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1119
Practice Address - Country:US
Practice Address - Phone:724-656-1510
Practice Address - Fax:724-656-4908
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029522L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice