1760601421 NPI number — DR. SEDDI MOUSSARI DMD

Table of content: DR. SEDDI MOUSSARI DMD (NPI 1760601421)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760601421 NPI number — DR. SEDDI MOUSSARI DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOUSSARI
Provider First Name:
SEDDI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760601421
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10401 GROSVENOR PL
Provider Second Line Business Mailing Address:
APT. #1506
Provider Business Mailing Address City Name:
N BETHESDA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-4646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-525-3523
Provider Business Mailing Address Fax Number:
858-525-3523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1712 EYE ST NW
Provider Second Line Business Practice Location Address:
600
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20006-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-331-0655
Provider Business Practice Location Address Fax Number:
202-331-0655
Provider Enumeration Date:
04/24/2007

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: 122300000X , with the licence number:  51788 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: D51788 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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