Provider Demographics
NPI:1205906526
Name:JAMES S MOSSOP DDS INC
Entity type:Organization
Organization Name:JAMES S MOSSOP DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOSSOP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-582-9055
Mailing Address - Street 1:1320 APPLE AVENUE STE 104
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-1552
Mailing Address - Country:US
Mailing Address - Phone:510-582-9055
Mailing Address - Fax:510-582-8147
Practice Address - Street 1:1320 APPLE AVENUE STE 104
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-1552
Practice Address - Country:US
Practice Address - Phone:510-582-9055
Practice Address - Fax:510-582-8147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33343204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty