Provider Demographics
NPI:1538403928
Name:MOSELEY, BRAD JUSTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:JUSTIN
Last Name:MOSELEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9099 KATY FWY
Mailing Address - Street 2:140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-1632
Mailing Address - Country:US
Mailing Address - Phone:713-465-1860
Mailing Address - Fax:281-768-7759
Practice Address - Street 1:9099 KATY FWY
Practice Address - Street 2:140
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1632
Practice Address - Country:US
Practice Address - Phone:713-465-1860
Practice Address - Fax:281-768-7759
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice