Provider Demographics
NPI:1912167248
Name:JOSEPH MOSS DDS & TYLER TEBAY DMD PS
Entity Type:Organization
Organization Name:JOSEPH MOSS DDS & TYLER TEBAY DMD PS
Other - Org Name:OLYMPIA ADVANCED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-357-8075
Mailing Address - Street 1:1105 4TH AVE E
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-4018
Mailing Address - Country:US
Mailing Address - Phone:360-357-8075
Mailing Address - Fax:360-357-3842
Practice Address - Street 1:1105 4TH AVE E
Practice Address - Street 2:SUITE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-4018
Practice Address - Country:US
Practice Address - Phone:360-357-8075
Practice Address - Fax:360-357-3842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000061161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty