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General NPI Number Information
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NPI Number | 1073606430
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Entity Type | Individual
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Provider Name | MARK ERIC MOSS DDS
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Gender | Male
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 09/22/2017
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Provider Practice Location Address
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Address Line | 1851 MACGREGOR DOWNS RD
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City | GREENVILLE
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State | NC
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Zip | 27834-5925
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Country | US
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Telephone | 252-737-7229
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Fax | 252-737-7757
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Provider Business Mailing Address
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Address Line | 1851 MACGREGOR DOWNS ROAD MAIL STOP 701 ECU SCHOOL OF DENTAL MEDICINE
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City | GREENVILLE
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State | NC
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Zip | 27834-4354
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Country | US
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Telephone | 252-737-7229
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Fax | 252-737-7757
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 050807-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0193
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License Number State | NC
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