Provider Demographics
NPI:1962650465
Name:MOSES, LITTLE BOSS (DMD)
Entity Type:Individual
Prefix:DR
First Name:LITTLE
Middle Name:BOSS
Last Name:MOSES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:L
Other - Middle Name:B
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:841 S. HWY 25W SUITE 9
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769
Mailing Address - Country:US
Mailing Address - Phone:606-549-4150
Mailing Address - Fax:606-549-1067
Practice Address - Street 1:841. S. HWY 25W SUITE 9
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769
Practice Address - Country:US
Practice Address - Phone:606-549-4150
Practice Address - Fax:606-549-1067
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY51851223G0001X
KY51851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice