Provider Demographics
NPI:1902822190
Name:MOSELEY, DARYL FREDERICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:FREDERICK
Last Name:MOSELEY
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 1:26206 W. 12 MILE RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-4803
Mailing Address - Country:US
Mailing Address - Phone:248-304-1385
Mailing Address - Fax:248-304-1387
Practice Address - Street 1:26206 W 12 MILE RD
Practice Address - Street 2:SUITE #100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1754
Practice Address - Country:US
Practice Address - Phone:248-304-1385
Practice Address - Fax:248-304-1387
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0125841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice