Active NPI
Minatullah Mousa
- General Practice Dentistry
- Orangeburg, SC
National Provider Identifier
1285314971
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 10594
- Practice address
- 1350 Grove Park Dr
Orangeburg, SC 29115-2455 - Phone
- (803) 855-0726
- NPI assigned
- Jul 19, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 10594 | SC | Primary |
Addresses
Primary practice location
1350 Grove Park Dr
Orangeburg, SC 29115-2455
Mailing address
421 Antebellum LN
Mount Pleasant, SC 29464-7851
Phone (614) 633-7616
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10594 | SC | MD | Physical Medicine & Rehabilitation Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1689724800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689724800000",
"number": "1285314971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "421 ANTEBELLUM LN",
"city": "MOUNT PLEASANT",
"state": "SC",
"postal_code": "294647851",
"telephone_number": "614-633-7616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 GROVE PARK DR",
"city": "ORANGEBURG",
"state": "SC",
"postal_code": "291152455",
"telephone_number": "803-855-0726"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOUSA",
"first_name": "MINATULLAH",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-07-19",
"last_updated": "2023-07-19",
"certification_date": "2023-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "10594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orangeburg, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.