Healthcare Provider Details

I. General information

NPI: 1306636048
Provider Name (Legal Business Name): CONNOR MOOS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 6180 BOX 245
APO AE
09604-0245
US

IV. Provider business mailing address

UNIT 6180 BOX 245
APO AE
09604-0245
US

V. Phone/Fax

Practice location:
  • Phone: 43-430-5060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14273930-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: