Provider Demographics
NPI:1891853495
Name:NEIL L MOSCOW DDS PC
Entity Type:Organization
Organization Name:NEIL L MOSCOW DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOSCOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:610-449-5010
Mailing Address - Street 1:510 DARBY ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083
Mailing Address - Country:US
Mailing Address - Phone:610-449-5010
Mailing Address - Fax:610-853-4691
Practice Address - Street 1:510 DARBY ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:610-449-5010
Practice Address - Fax:610-853-4691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018576L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty