Organization
JACKSON MOSES, DDS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACKSON MOSES DDS (PRESIDENT)
(949) 364-0220
Entity
Organization
Contact information
Practice address
27800 MEDICAL CENTER RD, 238, MISSION VIEJO, CA 92691-6410
(949) 364-0220
Mailing address
27800 MEDICAL CENTER ROAD, 238, MISSION VIEJO, CA 92691-6473
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
21174
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427162932
INDIVIDUAL NPI
CA
Enumeration date
01/02/2007
Last updated
08/22/2020
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