Provider Demographics
NPI:1205919461
Name:ROY C. MOSCATTINI DDS PC
Entity type:Organization
Organization Name:ROY C. MOSCATTINI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:SHURDEN
Authorized Official - Last Name:MOSCATTINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-476-4144
Mailing Address - Street 1:3660 HOWELL FERRY RD
Mailing Address - Street 2:BLDG A
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096
Mailing Address - Country:US
Mailing Address - Phone:770-476-4144
Mailing Address - Fax:770-813-8025
Practice Address - Street 1:3660 HOWELL FERRY RD
Practice Address - Street 2:BLDG A
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-476-4144
Practice Address - Fax:770-813-8025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA115261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty