Provider Demographics
NPI:1376639146
Name:MOSS, GREG (DDS)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
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 1:6565 E CARONDELET DR
Mailing Address - Street 2:SUITE #355
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2157
Mailing Address - Country:US
Mailing Address - Phone:520-733-9224
Mailing Address - Fax:520-722-0538
Practice Address - Street 1:6565 E CARONDELET DR
Practice Address - Street 2:SUITE #355
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2157
Practice Address - Country:US
Practice Address - Phone:520-733-9224
Practice Address - Fax:520-722-0538
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice