Provider Demographics
NPI:1407947724
Name:MOSHESHVILI, NATIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATIA
Middle Name:
Last Name:MOSHESHVILI
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 1:7020 108TH ST
Mailing Address - Street 2:APT 8B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4449
Mailing Address - Country:US
Mailing Address - Phone:917-776-6823
Mailing Address - Fax:
Practice Address - Street 1:11055 72ND RD
Practice Address - Street 2:SUITE L1
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5472
Practice Address - Country:US
Practice Address - Phone:718-268-1028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0507521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice