Provider Demographics
NPI:1962825828
Name:MONICA MOSLEY DDS, PC
Entity Type:Organization
Organization Name:MONICA MOSLEY DDS, PC
Other - Org Name:DANVILLE PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-492-3343
Mailing Address - Street 1:233 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-4926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4545 RIVERSIDE DR
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-5172
Practice Address - Country:US
Practice Address - Phone:434-791-2142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413346261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental