Provider Demographics
NPI:1720249907
Name:DR.SONIA MOUSSA DDS .PC.
Entity Type:Organization
Organization Name:DR.SONIA MOUSSA DDS .PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOUSSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-769-4585
Mailing Address - Street 1:4403 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5403
Mailing Address - Country:US
Mailing Address - Phone:773-769-4585
Mailing Address - Fax:773-769-4553
Practice Address - Street 1:4403 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5403
Practice Address - Country:US
Practice Address - Phone:773-769-4585
Practice Address - Fax:773-769-4553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190242341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty