1902974074 NPI number — DR. MICHAEL ERICH MOSSMANN DDS

Table of content: DR. MICHAEL ERICH MOSSMANN DDS (NPI 1902974074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902974074 NPI number — DR. MICHAEL ERICH MOSSMANN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSSMANN
Provider First Name:
MICHAEL
Provider Middle Name:
ERICH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOSSMANN
Provider Other First Name:
MICHAEL
Provider Other Middle Name:
ERICH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902974074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH LANCASTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01561-1208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-368-8474
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH LANCASTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-368-8474
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  21269 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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