Healthcare Provider Details

I. General information

NPI: 1700850344
Provider Name (Legal Business Name): DAXTON K. MOSS AU.D., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 SURFSIDE DR
SURFSIDE BEACH SC
29575-3807
US

IV. Provider business mailing address

835 SURFSIDE DR
SURFSIDE BEACH SC
29575-3807
US

V. Phone/Fax

Practice location:
  • Phone: 843-213-1593
  • Fax: 843-808-9759
Mailing address:
  • Phone: 843-213-1583
  • Fax: 843-808-8759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License Number30003472
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number30003472
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number8061
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number30003472
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: