Provider Demographics
NPI:1255745618
Name:MOOS, WILLIAM R (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:MOOS
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 1:1471 VALLEY ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-7899
Mailing Address - Country:US
Mailing Address - Phone:715-829-0960
Mailing Address - Fax:
Practice Address - Street 1:132 MONROE ST
Practice Address - Street 2:
Practice Address - City:MONDOVI
Practice Address - State:WI
Practice Address - Zip Code:54755-1731
Practice Address - Country:US
Practice Address - Phone:715-926-4237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7264 - 15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist