Provider Demographics
NPI:1164542114
Name:MOSS, STEVEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:M
Last Name:MOSS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37625 ANN ARBOR RD
Mailing Address - Street 2:SUITE108
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-2400
Mailing Address - Country:US
Mailing Address - Phone:734-744-4144
Mailing Address - Fax:734-402-7979
Practice Address - Street 1:37625 ANN ARBOR RD
Practice Address - Street 2:SUITE108
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2400
Practice Address - Country:US
Practice Address - Phone:734-744-4144
Practice Address - Fax:734-402-7979
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI156501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI381026938OtherTAX ID NUMBER