Provider Demographics
NPI:1417342403
Name:MOSES, CHARLENA (DA)
Entity Type:Individual
Prefix:
First Name:CHARLENA
Middle Name:
Last Name:MOSES
Suffix:
Gender:F
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9280 E RAINTREE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-7588
Mailing Address - Country:US
Mailing Address - Phone:480-443-9080
Mailing Address - Fax:480-607-0173
Practice Address - Street 1:9280 E RAINTREE DR
Practice Address - Street 2:SUITE 108
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-7588
Practice Address - Country:US
Practice Address - Phone:480-443-9080
Practice Address - Fax:480-607-0173
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant