Provider Demographics
NPI:1336225176
Name:MOSELEY, ANDREW W (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:W
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30039
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-0001
Mailing Address - Country:US
Mailing Address - Phone:931-552-1302
Mailing Address - Fax:931-552-4755
Practice Address - Street 1:2063 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6621
Practice Address - Country:US
Practice Address - Phone:931-552-1302
Practice Address - Fax:931-552-4755
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3259122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2008920OtherBLUE CROSS BLUE SHIELD
PA800959OtherUNITED CONCORDIA