Provider Demographics
NPI:1528796588
Name:GARY J. MOSIO D.D.S.
Entity type:Organization
Organization Name:GARY J. MOSIO D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-881-9400
Mailing Address - Street 1:17220 MACK AVE
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 AVE
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental