Provider Demographics
NPI:1760601421
Name:MOUSSARI, SEDDI (DMD)
Entity Type:Individual
Prefix:DR
First Name:SEDDI
Middle Name:
Last Name:MOUSSARI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10401 GROSVENOR PL
Mailing Address - Street 2:APT. #1506
Mailing Address - City:N BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4646
Mailing Address - Country:US
Mailing Address - Phone:858-525-3523
Mailing Address - Fax:858-525-3523
Practice Address - Street 1:1712 EYE ST NW
Practice Address - Street 2:600
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-3702
Practice Address - Country:US
Practice Address - Phone:202-331-0655
Practice Address - Fax:202-331-0655
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD51788Medicaid