Provider Demographics
NPI:1265000822
Name:AMMAR MOUSA DDS LLC
Entity Type:Organization
Organization Name:AMMAR MOUSA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-748-1880
Mailing Address - Street 1:590 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-4832
Mailing Address - Country:US
Mailing Address - Phone:352-748-1880
Mailing Address - Fax:352-748-3345
Practice Address - Street 1:590 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-4832
Practice Address - Country:US
Practice Address - Phone:352-748-1880
Practice Address - Fax:352-748-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental