Provider Demographics
NPI:1164301396
Name:MOSES DENTAL PLLC
Entity type:Organization
Organization Name:MOSES DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-549-4150
Mailing Address - Street 1:841 S HIGHWAY 25 W STE 9
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40769-4600
Mailing Address - Country:US
Mailing Address - Phone:606-549-4150
Mailing Address - Fax:606-549-1067
Practice Address - Street 1:841 S HIGHWAY 25 W STE 9
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:KY
Practice Address - Zip Code:40769-4600
Practice Address - Country:US
Practice Address - Phone:606-549-4150
Practice Address - Fax:606-549-1067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-01
Last Update Date:2025-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty