Provider Demographics
NPI:1043320807
Name:MOSS, GEORGE WASHINGTON III (DOS FAGD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WASHINGTON
Last Name:MOSS
Suffix:III
Gender:M
Credentials:DOS FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13843 HWY 105 W
Mailing Address - Street 2:#106
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304
Mailing Address - Country:US
Mailing Address - Phone:936-588-6999
Mailing Address - Fax:936-588-6998
Practice Address - Street 1:13843 HWY 105 W
Practice Address - Street 2:#106
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304
Practice Address - Country:US
Practice Address - Phone:936-588-6999
Practice Address - Fax:936-588-6998
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10536122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
10536OtherDENTIST