Provider Demographics
NPI:1972129054
Name:DAVIDOVITCH, MOSHE (DDS, MMSC)
Entity type:Individual
Prefix:DR
First Name:MOSHE
Middle Name:
Last Name:DAVIDOVITCH
Suffix:
Gender:M
Credentials:DDS, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 JABOTINSKY STREET
Mailing Address - Street 2:APT 3
Mailing Address - City:TEL AVIV
Mailing Address - State:ISRAEL
Mailing Address - Zip Code:6918400
Mailing Address - Country:IL
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:84 JABOTINSKY STREET
Practice Address - Street 2:APT 3
Practice Address - City:TEL AVIV
Practice Address - State:ISRAEL
Practice Address - Zip Code:6918400
Practice Address - Country:IL
Practice Address - Phone:050-556-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN174881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics