Provider Demographics
NPI:1376042853
Name:ALLEN MOSSAEI DDS INC
Entity Type:Organization
Organization Name:ALLEN MOSSAEI DDS INC
Other - Org Name:FIRST CHOICE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSSAEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-999-1501
Mailing Address - Street 1:4829 PANAMA LN UNIT C
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-3482
Mailing Address - Country:US
Mailing Address - Phone:661-999-1501
Mailing Address - Fax:661-412-4495
Practice Address - Street 1:4829 PANAMA LN UNIT C
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-3482
Practice Address - Country:US
Practice Address - Phone:661-999-1501
Practice Address - Fax:661-412-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59083261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental