Provider Demographics
NPI:1902979669
Name:J RYAN MOSES DMD PS
Entity Type:Organization
Organization Name:J RYAN MOSES DMD PS
Other - Org Name:MOSES ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:360-514-0055
Mailing Address - Street 1:16500 SE 15 ST
Mailing Address - Street 2:STE 150
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-514-0055
Mailing Address - Fax:360-514-0095
Practice Address - Street 1:16500 SE 15 ST
Practice Address - Street 2:STE 150
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:360-514-0055
Practice Address - Fax:360-514-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty