Provider Demographics
NPI:1659395440
Name:MOSKOWITZ, MARC (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:MOSKOWITZ
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 1:147 JOHNSON FERRY RD
Mailing Address - Street 2:STE. 4220
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4923
Mailing Address - Country:US
Mailing Address - Phone:770-956-0491
Mailing Address - Fax:
Practice Address - Street 1:147 JOHNSON FERRY RD
Practice Address - Street 2:STE. 4220
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4923
Practice Address - Country:US
Practice Address - Phone:770-956-0491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA93641223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics