Provider Demographics
NPI:1801853650
Name:MOSES, DONNA THOMAS (DMD, PC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:THOMAS
Last Name:MOSES
Suffix:
Gender:F
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 NEWNAN ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3344
Mailing Address - Country:US
Mailing Address - Phone:770-832-0089
Mailing Address - Fax:
Practice Address - Street 1:530 NEWNAN ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3344
Practice Address - Country:US
Practice Address - Phone:770-832-0089
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0110251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics