Provider Demographics
NPI:1902285992
Name:GREGG E MOSLEY PROFESSIONAL ASSOC
Entity Type:Organization
Organization Name:GREGG E MOSLEY PROFESSIONAL ASSOC
Other - Org Name:DEER PARK DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-479-8668
Mailing Address - Street 1:2705 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4955
Mailing Address - Country:US
Mailing Address - Phone:281-479-8668
Mailing Address - Fax:281-930-0400
Practice Address - Street 1:2705 CENTER ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4955
Practice Address - Country:US
Practice Address - Phone:281-479-8668
Practice Address - Fax:281-930-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0014960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty