Provider Demographics
NPI:1295929388
Name:DRS MOSS AND OWEN
Entity type:Organization
Organization Name:DRS MOSS AND OWEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-432-2155
Mailing Address - Street 1:PO BOX 1647
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29021
Mailing Address - Country:US
Mailing Address - Phone:803-432-2155
Mailing Address - Fax:803-432-7744
Practice Address - Street 1:310 HAMPTON PARK
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020
Practice Address - Country:US
Practice Address - Phone:803-432-2155
Practice Address - Fax:803-432-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC1815-DR MOSS1223G0001X
SCSC2127-DR OWEN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC821272Medicaid