Provider Demographics
NPI:1336555754
Name:MOSHEA, MEGAN (DDS)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:
Last Name:MOSHEA
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 1:11518 SAN JOSE BLVD # A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7237
Mailing Address - Country:US
Mailing Address - Phone:904-268-5600
Mailing Address - Fax:
Practice Address - Street 1:11518 SAN JOSE BLVD # A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7237
Practice Address - Country:US
Practice Address - Phone:904-268-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-07
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 20782122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20782OtherDENTAL LICENSE