Provider Demographics
NPI:1235573932
Name:MOSS, MARCUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:MOSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 7TH AVE SOUTH SDB 304
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0007
Mailing Address - Country:US
Mailing Address - Phone:205-934-1315
Mailing Address - Fax:
Practice Address - Street 1:1919 7TH AVE SOUTH SDB 304
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0007
Practice Address - Country:US
Practice Address - Phone:205-934-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLN0 6004122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist