Provider Demographics
NPI:1164457636
Name:MOSS, DOUGLAS ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ROBERT
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 1:836 W WOOD ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWS
Mailing Address - State:CA
Mailing Address - Zip Code:95988-2322
Mailing Address - Country:US
Mailing Address - Phone:530-934-7720
Mailing Address - Fax:
Practice Address - Street 1:836 W WOOD ST
Practice Address - Street 2:
Practice Address - City:WILLOWS
Practice Address - State:CA
Practice Address - Zip Code:95988-2322
Practice Address - Country:US
Practice Address - Phone:530-934-7720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice