Organization
ADVANCIA DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HAITHAM MOSLY DMD (PRESIDENT)
(651) 207-9660
Entity
Organization
Contact information
Practice address
1625 RADIO DR, SUITE 170, WOODBURY, MN 55125-9407
(651) 207-9660
Mailing address
3154 MEADOW BROOK DR, WOODBURY, MN 55125-4308
(651) 207-9660
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12156
MN
Other
Enumeration date
08/03/2008
Last updated
08/03/2008
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