Individual
BRADLEY LEE MOSES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7030 YOUREE DR STE B, SHREVEPORT, LA 71105-5109
(318) 402-4604
Mailing address
4835 HEARST ST APT 207, METAIRIE, LA 70001-1192
(913) 602-0519
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6975
LA
Other
Enumeration date
05/29/2018
Last updated
06/07/2019
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