Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3442 | LA |
NPI | 1033109186 |
---|---|
Provider Name | Dr. Philip D Moses |
First Address | Lake Charles, LA 70605-1521 |
Second Address | Lake Charles, LA 70605-1521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 01/08/2017 |