Provider Demographics
NPI:1669559357
Name:MOSHOS, DEE DENNIS SR (DDS)
Entity type:Individual
Prefix:DR
First Name:DEE
Middle Name:DENNIS
Last Name:MOSHOS
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:34 LAKE HAVASU AVE N STE 5
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5639
Mailing Address - Country:US
Mailing Address - Phone:929-453-5577
Mailing Address - Fax:928-453-1661
Practice Address - Street 1:34 LAKE HAVASU AVE N STE 5
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5639
Practice Address - Country:US
Practice Address - Phone:929-453-5577
Practice Address - Fax:928-453-1661
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
520126OtherUNITED CONCORDIA
AZ0418650OtherBLUE CROSS BLUE SHIELD