Provider Demographics
NPI:1447414958
Name:MOSLEY, GREGG (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4955
Mailing Address - Country:US
Mailing Address - Phone:281-479-8668
Mailing Address - Fax:281-930-0400
Practice Address - Street 1:2705 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4955
Practice Address - Country:US
Practice Address - Phone:281-479-8668
Practice Address - Fax:281-930-0400
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice