Provider Demographics
NPI:1083763056
Name:ROBERT E MOSES III DDS INC
Entity Type:Organization
Organization Name:ROBERT E MOSES III DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:580-772-7747
Mailing Address - Street 1:1204 E MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096
Mailing Address - Country:US
Mailing Address - Phone:580-772-7747
Mailing Address - Fax:580-772-0216
Practice Address - Street 1:1204 E MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096
Practice Address - Country:US
Practice Address - Phone:580-772-7747
Practice Address - Fax:580-772-0216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty