Provider Demographics
NPI:1730428772
Name:DAVID A. MOSAL, DDS, PA
Entity type:Organization
Organization Name:DAVID A. MOSAL, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-956-9595
Mailing Address - Street 1:5856 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2617
Mailing Address - Country:US
Mailing Address - Phone:601-956-9595
Mailing Address - Fax:601-956-9883
Practice Address - Street 1:5856 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-2617
Practice Address - Country:US
Practice Address - Phone:601-956-9595
Practice Address - Fax:601-956-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3475-08122300000X
MS1585-73122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1972767143OtherTYPE 1 NPI
MS1154463321OtherTYPE 1 NPI