Provider Demographics
NPI:1255405171
Name:MOSS, DANIEL RAY (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RAY
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 1:2403 INDIAN CAMP TRL
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-3987
Mailing Address - Country:US
Mailing Address - Phone:254-518-5133
Mailing Address - Fax:
Practice Address - Street 1:1005 W HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-3886
Practice Address - Country:US
Practice Address - Phone:254-542-5750
Practice Address - Fax:254-542-4832
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice