Provider Demographics
NPI:1942406079
Name:MOSS, CHRISTOPHER J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:J
Last Name:MOSS
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 1:203 E MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-4350
Mailing Address - Country:US
Mailing Address - Phone:307-857-2020
Mailing Address - Fax:307-857-2727
Practice Address - Street 1:203 E MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-4350
Practice Address - Country:US
Practice Address - Phone:307-857-2020
Practice Address - Fax:307-857-2727
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY12201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice