Provider Demographics
NPI:1568936888
Name:JENNIFER D MOSS, RDHAP, INC
Entity Type:Organization
Organization Name:JENNIFER D MOSS, RDHAP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:BS,RDH,RDHAP
Authorized Official - Phone:951-252-4863
Mailing Address - Street 1:33276 PALOMA RD
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-9459
Mailing Address - Country:US
Mailing Address - Phone:951-252-4863
Mailing Address - Fax:
Practice Address - Street 1:33276 PALOMA RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-9459
Practice Address - Country:US
Practice Address - Phone:951-252-4863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty