Provider Demographics
NPI:1356310510
Name:MOSS, JAMES L III (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:MOSS
Suffix:III
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 1:24 MILLDAM RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-5847
Mailing Address - Country:US
Mailing Address - Phone:978-263-4183
Mailing Address - Fax:
Practice Address - Street 1:24 MILLDAM RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-5847
Practice Address - Country:US
Practice Address - Phone:978-263-4183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPH139OtherHARVARD PILGRIM
MAX04847OtherBCBS - DENTAL