Active NPI
Emile K Moussaed, DDS
- General Practice Dentistry
- Shreveport, LA
National Provider Identifier
1114032489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6357
- Practice address
- 1297 Shreveport Barksdale Hwy
Shreveport, LA 71105-2405 - Phone
- (318) 865-8844
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3845 | WI | |
| General Practice Dentistry | 1223G0001X | 6357 | OK | Primary |
Addresses
Primary practice location
1297 Shreveport Barksdale Hwy
Shreveport, LA 71105-2405
Mailing address
1002 Elmsmere Dr
Northville, MI 48167-1065
Phone (248) 449-8833
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3845 | Other | WI | DENTAL LICENSE |
| 33501200 | Medicaid | WI | |
| 2901014893 | Other | MI | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387152000000",
"number": "1114032489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1002 ELMSMERE DR",
"city": "NORTHVILLE",
"state": "MI",
"postal_code": "481671065",
"telephone_number": "248-449-8833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1297 SHREVEPORT BARKSDALE HWY",
"city": "SHREVEPORT",
"state": "LA",
"postal_code": "711052405",
"telephone_number": "318-865-8844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUSSAED",
"first_name": "EMILE",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2013-12-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "3845",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OK",
"license": "6357",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "3845",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "33501200",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "2901014893",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shreveport, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.