| Moses Family Dentistry, Llc | |
|
1776 N Airline Hwy Ste B Gonzales LA 70737-2127 | |
| (225) 369-0481 | |
| (225) 369-0482 |
| Full Name | Moses Family Dentistry, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1776 N Airline Hwy Ste B, Gonzales, Louisiana |
| Authorized Official Name and Position | Bradley Lee Moses (OWNER) |
| Authorized Official Contact | 9136020519 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Moses Family Dentistry, Llc 1535 River Parkway Blvd Apt 1002 Shreveport LA 71104-1812 Ph: (913) 602-0519 | Moses Family Dentistry, Llc 1776 N Airline Hwy Ste B Gonzales LA 70737-2127 Ph: (225) 369-0481 |
| NPI Number | 1952007197 |
|---|---|
| Provider Enumeration Date | 01/31/2023 |
| Last Update Date | 01/31/2023 |
| Medicare PECOS PAC ID | 2365808482 |
|---|---|
| Medicare Enrollment ID | O20230516001929 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952007197 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Bradley Lee Moses |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1417448200 PECOS PAC ID: 3274999396 Enrollment ID: I20230516002094 |
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