Individual
DR. ETHAN MOSKOVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
324 ELMIRA RD STE 200, ITHACA, NY 14850-5106
(607) 273-3000
Mailing address
73 MURIEL AVE, LAWRENCE, NY 11559-1810
(516) 660-6367
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
060576
NY
Other
Enumeration date
05/30/2018
Last updated
12/11/2019
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