Provider Demographics
NPI:1144309196
Name:MOSS & ASSOCIATES GENERAL DENTISTRY LLC
Entity type:Organization
Organization Name:MOSS & ASSOCIATES GENERAL DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-223-1152
Mailing Address - Street 1:1815 MONTAGUE AVENUE EXTENSION
Mailing Address - Street 2:UNIT 1
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649
Mailing Address - Country:US
Mailing Address - Phone:864-223-1152
Mailing Address - Fax:864-223-4276
Practice Address - Street 1:1815 MONTAGUE AVENUE EXTENSION
Practice Address - Street 2:UNIT 1
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649
Practice Address - Country:US
Practice Address - Phone:864-223-1152
Practice Address - Fax:864-223-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC2124122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9604Medicare ID - Type Unspecified