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General NPI Number Information
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NPI Number | 1417335787
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Entity Type | Organization
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Legal Business Name | MERIT DENTAL OF MASSACHUSETTS PC
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Dates
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Enumeration Date | 05/07/2015
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Last Update Date | 05/07/2015
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Provider Practice Location Address
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Address Line | 680 HEHLI WAY
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City | MONDOVI
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State | WI
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Zip | 54755-1639
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Country | US
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Telephone | 715-926-5050
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Fax | 715-318-3449
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Provider Business Mailing Address
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Address Line | 680 HEHLI WAY
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City | MONDOVI
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State | WI
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Zip | 54755-1639
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Country | US
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Telephone | 715-926-5050
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Fax | 715-318-3449
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Authorized Official
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Title or Position | PC OWNER
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Name | DR. JEFFREY MOOS
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Credential | DDS
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Telephone | 715-926-5050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1856841
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License Number State | MA
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