Individual
JAKLEEN MOUSSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
4744 S FLORIDA AVE, LAKELAND, FL 33813-2181
(863) 644-1226
Mailing address
511 VINTAGE WAY, BRANDON, FL 33511-6365
(813) 758-3337
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
22849
FL
Other
Enumeration date
12/03/2020
Last updated
12/03/2020
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