Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN24924 | FL |
N | 122300000X | Dentist | RES.004125 | OH |
NPI | 1003476581 |
---|---|
Provider Name | Dr. Paul Mosad |
First Address | Tarpon Springs, FL 34689-5446 |
Second Address | Trinity, FL 34655-1106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 02/03/2021 |