Provider Demographics
NPI:1396415097
Name:MOOS FAMILY DENTAL, PC
Entity Type:Organization
Organization Name:MOOS FAMILY DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-586-4961
Mailing Address - Street 1:1288 N 14TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8534
Mailing Address - Country:US
Mailing Address - Phone:406-586-4961
Mailing Address - Fax:
Practice Address - Street 1:1288 N 14TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8534
Practice Address - Country:US
Practice Address - Phone:406-586-4961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty