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Organization
THERESE MOUSSA, DDS, PC
Active
Organization
THERESE MOUSSA, DDS, PC
Active
Other names
Clark Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESE MOUSSA D.D.S. (OWNER)
(773) 622-4950
Entity
Organization
Contact information
Practice address
5301 W FULLERTON AVE, CHICAGO, IL 60639-1424
(773) 622-4950
Mailing address
5301 W FULLERTON AVE, CHICAGO, IL 60639-1424
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019027661
IL
Other
Enumeration date
03/12/2017
Last updated
03/12/2017
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