Provider Demographics
NPI:1306048921
Name:MOSIO, GARY JOSEPH (DDS)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:JOSEPH
Last Name:MOSIO
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 1:17220 MACK AVENUE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-6254
Mailing Address - Country:US
Mailing Address - Phone:313-881-9400
Mailing Address - Fax:313-881-2736
Practice Address - Street 1:17220 MACK AVENUE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-6254
Practice Address - Country:US
Practice Address - Phone:313-881-9400
Practice Address - Fax:313-881-2736
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010122031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice