Basic Information
| Provider Information | |||||||||
| NPI: | 1598363970 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STEVEN M MOSS DDS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7225 S OAK CT W | ||||||||
| Address2: | |||||||||
| City: | WEST BLOOMFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483232078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483966696 | ||||||||
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| Practice Location | |||||||||
| Address1: | 37625 ANN ARBOR RD STE 108 | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481502400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347444144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2020 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| AuthorizedOfficialLastName: | RUNYON | ||||||||
| AuthorizedOfficialFirstName: | HEATHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2483966696 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | STEVEN M MOSS DDS PC | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
No ID Information.