Provider Demographics
NPI:1598363970
Name:STEVEN M MOSS DDS PC
Entity Type:Organization
Organization Name:STEVEN M MOSS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-396-6696
Mailing Address - Street 1:7225 S OAK CT W
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2078
Mailing Address - Country:US
Mailing Address - Phone:248-396-6696
Mailing Address - Fax:
Practice Address - Street 1:37625 ANN ARBOR RD STE 108
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-2400
Practice Address - Country:US
Practice Address - Phone:734-744-4144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN M MOSS DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental