Provider Demographics
NPI:1235302332
Name:ALCANTARA, MOSES L (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MOSES
Middle Name:L
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 N CAPITOL AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2570
Mailing Address - Country:US
Mailing Address - Phone:408-926-1995
Mailing Address - Fax:408-926-1997
Practice Address - Street 1:1155 N CAPITOL AVE
Practice Address - Street 2:STE 150
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2570
Practice Address - Country:US
Practice Address - Phone:408-926-1995
Practice Address - Fax:408-926-1997
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics