Provider Demographics
NPI:1750483400
Name:MOOS, HEIDI LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LEE
Last Name:MOOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3849 WATKINS MILL DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-6448
Mailing Address - Country:US
Mailing Address - Phone:703-960-6055
Mailing Address - Fax:
Practice Address - Street 1:NATIONAL NAVAL MEDICAL CTR
Practice Address - Street 2:8901 WISCONSIN AVENUE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5600
Practice Address - Country:US
Practice Address - Phone:301-319-4794
Practice Address - Fax:301-295-5928
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024564L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics