Provider Demographics
NPI:1063541837
Name:MOSELEY, DENISE E (DDS)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:E
Last Name:MOSELEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 STALCUP RD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-1726
Mailing Address - Country:US
Mailing Address - Phone:817-702-7185
Mailing Address - Fax:
Practice Address - Street 1:3301 STALCUP RD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-1726
Practice Address - Country:US
Practice Address - Phone:817-702-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX162891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice