Healthcare Provider Details

I. General information

NPI: 1508819970
Provider Name (Legal Business Name): DEAN V MOESCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER DR
HARDEEVILLE SC
29927-3446
US

IV. Provider business mailing address

PO BOX 15479
SAVANNAH GA
31416-2179
US

V. Phone/Fax

Practice location:
  • Phone: 912-629-0457
  • Fax: 912-629-0468
Mailing address:
  • Phone: 912-629-0457
  • Fax: 912-629-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2012-01179
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MP00560400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14702
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number027873
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: