Provider Demographics
NPI:1467547786
Name:MOSLEY, MELVIN LEWIS (DDS)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:LEWIS
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:PO BOX 442
Mailing Address - Street 2:
Mailing Address - City:DUNBAR
Mailing Address - State:WV
Mailing Address - Zip Code:25064-3306
Mailing Address - Country:US
Mailing Address - Phone:304-768-3292
Mailing Address - Fax:
Practice Address - Street 1:221 DUNBAR AVE
Practice Address - Street 2:
Practice Address - City:DUNBAR
Practice Address - State:WV
Practice Address - Zip Code:25064-3306
Practice Address - Country:US
Practice Address - Phone:304-768-3292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0135728000Medicaid