Provider Demographics
NPI:1053491290
Name:MOSS, JAMIE KATHLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:KATHLEEN
Last Name:MOSS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 FROST LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5164
Mailing Address - Country:US
Mailing Address - Phone:630-778-0824
Mailing Address - Fax:
Practice Address - Street 1:1747 FROST LN
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5164
Practice Address - Country:US
Practice Address - Phone:630-778-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice