Provider Demographics
NPI:1184662140
Name:MOSELEY, PATRICK PAUL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:PAUL
Last Name:MOSELEY
Suffix:JR
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 1:305 N SPRING ST
Mailing Address - Street 2:
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-3317
Mailing Address - Country:US
Mailing Address - Phone:870-352-5161
Mailing Address - Fax:870-352-7510
Practice Address - Street 1:305 N SPRING ST
Practice Address - Street 2:
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-3317
Practice Address - Country:US
Practice Address - Phone:870-352-5161
Practice Address - Fax:870-352-7510
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR117159608Medicaid