Active NPI
Haitham Mosly, DMD
- Dentist
- Citrus Heights, CA
National Provider Identifier
1952407504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D12156
- Practice address
- 6406 Sunrise Blvd
Citrus Heights, CA 95610-5992 - Phone
- (916) 727-1880
- NPI assigned
- Sep 14, 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 |
|---|---|---|---|---|
| Dentist | 122300000X | D12156 | MN | Primary |
| Dentist | 122300000X | 61008 | CA |
Addresses
Primary practice location
6406 Sunrise Blvd
Citrus Heights, CA 95610-5992
Mailing address
751 Central Park Dr Apt 3611
Roseville, CA 95678-3530
Phone (651) 207-9660
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9181169 | Other | MN | U-CARE/DORAL |
| 019170100 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Sep 23, 2015 through Sep 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12156 | MN | MD | Dentist |
| 61008 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Haitham Mosly, DMD, a Professional Corporation | Dentist | Past | Accepting new patients |
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.
-
- Dentist
- Roseville, CA
- NPI 1427435809
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392595200000",
"number": "1952407504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "751 CENTRAL PARK DR APT 3611",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956783530",
"telephone_number": "651-207-9660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6406 SUNRISE BLVD",
"city": "CITRUS HEIGHTS",
"state": "CA",
"postal_code": "956105992",
"telephone_number": "916-727-1880"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSLY",
"first_name": "HAITHAM",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-14",
"last_updated": "2014-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D12156",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "61008",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "U-CARE/DORAL",
"identifier": "9181169",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019170100",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Citrus Heights, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.