Provider Demographics
NPI:1073606430
Name:MOSS, MARK ERIC (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ERIC
Last Name:MOSS
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 1:1851 MACGREGOR DOWNS ROAD MAIL STOP 701
Mailing Address - Street 2:ECU SCHOOL OF DENTAL MEDICINE
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-4354
Mailing Address - Country:US
Mailing Address - Phone:252-737-7229
Mailing Address - Fax:252-737-7757
Practice Address - Street 1:1851 MACGREGOR DOWNS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5925
Practice Address - Country:US
Practice Address - Phone:252-737-7229
Practice Address - Fax:252-737-7757
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050807-1122300000X
NC0193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist