Advancia Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12156 Issued in MN

Legal business name

ADVANCIA DENTAL

Practice address

1625 Radio Dr
Suite 170
Woodbury, MN 55125-9407

Phone

(651) 207-9660

NPI assigned

Aug 3, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Haitham Mosly, DMD

Title

President

Phone

(651) 207-9660

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217721600000",
    "number": "1124284732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3154 MEADOW BROOK DR",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254308",
            "telephone_number": "651-207-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 RADIO DR",
            "address_2": "SUITE 170",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551259407",
            "telephone_number": "651-207-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCIA DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-03",
        "last_updated": "2008-08-03",
        "status": "A",
        "authorized_official_last_name": "MOSLY",
        "authorized_official_first_name": "HAITHAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "651-207-9660",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12156",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Woodbury, MN
• Providers in Woodbury, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.