Provider Demographics
NPI:1497357552
Name:MOSS, DAVID KENT I (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KENT
Last Name:MOSS
Suffix:I
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 1:23 MOSS RD
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-5726
Mailing Address - Country:US
Mailing Address - Phone:304-636-6015
Mailing Address - Fax:
Practice Address - Street 1:23 MOSS RD
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-5726
Practice Address - Country:US
Practice Address - Phone:304-636-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist