Provider Demographics
NPI:1336349166
Name:TINA P. MOSES, DMD, PC
Entity Type:Organization
Organization Name:TINA P. MOSES, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-863-6262
Mailing Address - Street 1:1240 AUGUSTA WEST PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1854
Mailing Address - Country:US
Mailing Address - Phone:706-863-6262
Mailing Address - Fax:706-863-6465
Practice Address - Street 1:1240 AUGUSTA WEST PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1854
Practice Address - Country:US
Practice Address - Phone:706-863-6262
Practice Address - Fax:706-863-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0120361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty