Provider Demographics
NPI:1275610792
Name:MOSES, RICHARD JAMES III (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAMES
Last Name:MOSES
Suffix:III
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 1:397 KUNKEL AVE
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9337
Mailing Address - Country:US
Mailing Address - Phone:717-566-3776
Mailing Address - Fax:
Practice Address - Street 1:397 KUNKEL AVE
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9337
Practice Address - Country:US
Practice Address - Phone:717-566-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014108671223P0221X
PADS0354951223X0400X, 1223P0221X
NY054790390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223P0221XDental ProvidersDentistPediatric Dentistry
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics