Provider Demographics
NPI:1891312039
Name:MOSES, PRINCE B (DDS)
Entity Type:Individual
Prefix:DR
First Name:PRINCE
Middle Name:B
Last Name:MOSES
Suffix:
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 1:2339 WESTPORT LN
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1210
Mailing Address - Country:US
Mailing Address - Phone:518-649-3046
Mailing Address - Fax:
Practice Address - Street 1:9510 LANHAM SEVERN RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2624
Practice Address - Country:US
Practice Address - Phone:301-459-5901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-04
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist