Provider Demographics
NPI:1972767143
Name:MOSAL, SETH HUNTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:HUNTER
Last Name:MOSAL
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 1:5856 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2617
Mailing Address - Country:US
Mailing Address - Phone:601-956-9595
Mailing Address - Fax:601-956-9883
Practice Address - Street 1:5856 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2617
Practice Address - Country:US
Practice Address - Phone:601-956-9595
Practice Address - Fax:601-956-9883
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3475-08122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist