Provider Demographics
NPI:1669172102
Name:MOSER, BENJAMIN ARTHUR (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ARTHUR
Last Name:MOSER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E SILVERADO RANCH BLVD UNIT 2051
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7210
Mailing Address - Country:US
Mailing Address - Phone:916-880-0372
Mailing Address - Fax:
Practice Address - Street 1:555 E SILVERADO RANCH BLVD UNIT 2051
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-7210
Practice Address - Country:US
Practice Address - Phone:916-880-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-589-231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice