Provider Demographics
NPI:1932329844
Name:DONNA THOMAS MOSES, DMD, PC
Entity Type:Organization
Organization Name:DONNA THOMAS MOSES, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIS
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-832-0089
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:770-830-9531
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:770-830-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty