Provider Demographics
NPI:1558481697
Name:MOSES, ROBERT ELMER III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELMER
Last Name:MOSES
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 1:1204 E MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:WEATHERFORD
Mailing Address - State:OK
Mailing Address - Zip Code:73096-5770
Mailing Address - Country:US
Mailing Address - Phone:580-772-7747
Mailing Address - Fax:580-772-0216
Practice Address - Street 1:1204 E MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:WEATHERFORD
Practice Address - State:OK
Practice Address - Zip Code:73096-5770
Practice Address - Country:US
Practice Address - Phone:580-772-7747
Practice Address - Fax:580-772-0216
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice