Provider Demographics
NPI:1104491661
Name:AMMAR MOUSA DDS LLC
Entity type:Organization
Organization Name:AMMAR MOUSA DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:AMMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-461-0599
Mailing Address - Street 1:717 KRISTINE WAY
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-0099
Mailing Address - Country:US
Mailing Address - Phone:352-461-0599
Mailing Address - Fax:352-748-3345
Practice Address - Street 1:717 KRISTINE WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-0099
Practice Address - Country:US
Practice Address - Phone:352-461-0599
Practice Address - Fax:352-748-3345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental