Provider Demographics
NPI:1700850344
Name:MOSS, DAXTON K (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:DAXTON
Middle Name:K
Last Name:MOSS
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17390 PRESTON RD
Mailing Address - Street 2:STE. 320
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5791
Mailing Address - Country:US
Mailing Address - Phone:972-733-3344
Mailing Address - Fax:972-733-3852
Practice Address - Street 1:17390 PRESTON RD
Practice Address - Street 2:STE. 320
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-5791
Practice Address - Country:US
Practice Address - Phone:972-733-3344
Practice Address - Fax:972-733-3852
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80518231H00000X, 231HA2400X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Practitioner
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK22446Medicare PIN
ILP00259842Medicare PIN
S96517Medicare UPIN