OrganizationMoua Family Dentistry PcClinic/CenterAmbulatory Health Care FacilitiesPractice Address1714 Cope Ave E, Maplewood, MN 55109-2664(763) 645-4737PECOS EnrollmentBased on the most recent information from CMS, provider Moua Family Dentistry Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1922718030Provider TypeOrganizationFull NameMoua Family Dentistry PcSubpartNoEnumeration Date11/29/2022Last Updated11/29/2022Contact InformationPractice LocationPractice Address1714 Cope Ave E, Maplewood, MN 55109-2664Phone(763) 645-4737FaxUnlisted FaxMailing LocationMailing Address1714 Cope Ave E, Maplewood, MN 55109-2664PhoneUnlisted PhoneFaxUnlisted FaxAuthorized OfficialNameMoua, Chia (Ceo)Phone(763) 645-4737Provider TaxonomiesCodeDescriptionLicenseCode261QD0000XPrimaryDescriptionClinic/CenterAmbulatory Health Care FacilitiesLicenseUnlisted Issuer