Provider Demographics
NPI:1205291119
Name:JMMDDS PLLC
Entity type:Organization
Organization Name:JMMDDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MOOSSY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-459-5437
Mailing Address - Street 1:4200 N LAMAR BLVD
Mailing Address - Street 2:STE. 145
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3712
Mailing Address - Country:US
Mailing Address - Phone:512-459-5437
Mailing Address - Fax:512-459-8342
Practice Address - Street 1:4203 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3309
Practice Address - Country:US
Practice Address - Phone:512-371-7239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty