Provider Demographics
NPI:1952871030
Name:HARVEY MOSSAK ORAL & MAXILLOFACIAL SURGERY, PLLC
Entity Type:Organization
Organization Name:HARVEY MOSSAK ORAL & MAXILLOFACIAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSSAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-572-0599
Mailing Address - Street 1:1211 E KENNEDY BLVD UNIT 223
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3559
Mailing Address - Country:US
Mailing Address - Phone:972-572-0599
Mailing Address - Fax:813-654-7824
Practice Address - Street 1:1211 E KENNEDY BLVD UNIT 223
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3559
Practice Address - Country:US
Practice Address - Phone:972-572-0599
Practice Address - Fax:813-654-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL631YOOtherFLORIDA BLUE