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Organization
SHANEKA MARKS MOSS DDS PC
Active
Organization
SHANEKA MARKS MOSS DDS PC
Active
Other names
Lavender Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANEKA MARKS MOSS DDS (OWNER)
(972) 352-6677
Entity
Organization
Contact information
Practice address
5103 MAGNA CARTA BLVD, SUITE 100, GRAND PRAIRIE, TX 75052-5213
(972) 352-6677
(972) 352-6678
Mailing address
5103 MAGNA CARTA BLVD, SUITE 100, GRAND PRAIRIE, TX 75052-5213
(972) 352-6677
(972) 352-6678
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
25693
TX
Other
Enumeration date
09/23/2013
Last updated
09/23/2013
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