Individual provider Active NPI

Selvana Moussa, DDS

  • Dentist
  • Lithia, FL
National Provider Identifier
1821724220
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN27205 Issued in FL
Practice address
5628 Circa Fishhawk Blvd
Lithia, FL 33547-4218
Phone
(813) 324-5795
NPI assigned
Jul 27, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN27205 FL Primary

Addresses

Primary practice location

5628 Circa Fishhawk Blvd
Lithia, FL 33547-4218

Mailing address

3131 Pullman Car Dr Apt 201
Valrico, FL 33594-3378
Phone (615) 299-7917

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

LicenseStateTypeSpecialty
DN27205FLMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Comfortable Care Dental Health Professionals, P.a. CurrentSince Jul 31, 2022 Accepting new patients

Locations

5628 Circa Fishhawk Blvd
Lithia, FL 33547
Phone (813) 324-5795

Networks

  • Freedom Health HMO Network

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1658880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1821724220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 PULLMAN CAR DR APT 201",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335943378",
            "telephone_number": "615-299-7917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5628 CIRCA FISHHAWK BLVD",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335474218",
            "telephone_number": "813-324-5795"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUSSA",
        "first_name": "SELVANA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-27",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN27205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithia, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; 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.