Individual
MOSES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
714 AVENUE C, FORT PIERCE, FL 34950-4189
(772) 462-3833
(772) 462-3865
Mailing address
5150 NW MILNER DR, PORT ST LUCIE, FL 34983-3392
(772) 462-3833
(772) 462-3865
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
DN14317
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN14317
MEDICAL LICENSE
FL
Enumeration date
01/11/2007
Last updated
07/09/2007
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