Provider Demographics
NPI:1821420092
Name:MOOSA, DANNY (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:
Last Name:MOOSA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4091 POWELL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7372
Mailing Address - Country:US
Mailing Address - Phone:614-659-0018
Mailing Address - Fax:
Practice Address - Street 1:4091 POWELL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-7372
Practice Address - Country:US
Practice Address - Phone:614-659-0018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024288122300000X
PADS040140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist