Provider Demographics
NPI:1902974074
Name:MOSSMANN, MICHAEL ERICH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERICH
Last Name:MOSSMANN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:ERICH
Other - Last Name:MOSSMANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:SOUTH LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01561-1208
Mailing Address - Country:US
Mailing Address - Phone:978-368-8474
Mailing Address - Fax:
Practice Address - Street 1:240 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SOUTH LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01561
Practice Address - Country:US
Practice Address - Phone:978-368-8474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice