Provider Demographics
NPI:1073965174
Name:MOUSSA, NABIL (DDS)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:
Last Name:MOUSSA
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 1:3700 INGLESIDE BLVD #101
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456
Mailing Address - Country:US
Mailing Address - Phone:843-936-5061
Mailing Address - Fax:
Practice Address - Street 1:3700 INGLESIDE BLVD # 101
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4141
Practice Address - Country:US
Practice Address - Phone:843-936-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1230651223S0112X
SC104791223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery