Provider Demographics
NPI:1033235379
Name:MOSER, VELDON ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:VELDON
Middle Name:ROSS
Last Name:MOSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9248
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-9248
Mailing Address - Country:US
Mailing Address - Phone:307-733-7044
Mailing Address - Fax:307-734-1409
Practice Address - Street 1:1115 MAPLE WAY
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-733-7044
Practice Address - Fax:307-734-1409
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5512974OtherCHIP
MT0130152Medicaid