Provider Demographics
NPI:1306977053
Name:PATRICK P MOSELEY FAMILY DENTISTRY
Entity type:Organization
Organization Name:PATRICK P MOSELEY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-352-5161
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:305 NORTH SPRING STREET
Mailing Address - City:FORDYCE
Mailing Address - State:AR
Mailing Address - Zip Code:71742-0640
Mailing Address - Country:US
Mailing Address - Phone:870-352-5161
Mailing Address - Fax:870-352-7510
Practice Address - Street 1:305 N SPRING ST
Practice Address - Street 2:BOX 640
Practice Address - City:FORDYCE
Practice Address - State:AR
Practice Address - Zip Code:71742-3317
Practice Address - Country:US
Practice Address - Phone:870-352-5161
Practice Address - Fax:870-352-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR29141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty