Provider Demographics
NPI:1346449758
Name:MOSLEY, MONICA S (DDS)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:S
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9072
Mailing Address - Country:US
Mailing Address - Phone:678-836-2136
Mailing Address - Fax:
Practice Address - Street 1:1040 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9072
Practice Address - Country:US
Practice Address - Phone:678-836-2136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0232721223G0001X
GADN0141901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice