Provider Demographics
NPI:1144537564
Name:MOURSELAS DENTAL PLLC
Entity type:Organization
Organization Name:MOURSELAS DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURSELAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-261-7291
Mailing Address - Street 1:201 8TH ST. SOUTH
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-6141
Mailing Address - Country:US
Mailing Address - Phone:239-261-7291
Mailing Address - Fax:239-261-3893
Practice Address - Street 1:201 8TH ST S
Practice Address - Street 2:SUITE 106
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6107
Practice Address - Country:US
Practice Address - Phone:239-261-7291
Practice Address - Fax:239-261-3893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN167931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty