Provider Demographics
NPI:1386379303
Name:MEGAN MOSHEA D.D.S. LLC
Entity type:Organization
Organization Name:MEGAN MOSHEA D.D.S. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSHEA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-268-5600
Mailing Address - Street 1:11518 SAN JOSE BLVD
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
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1336555754OtherNPI