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General NPI Number Information
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NPI Number | 1497540777
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Entity Type | Organization
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Legal Business Name | MOOS DENTAL OF MONTANA PLLC
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 1700 W KOCH ST STE 1
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City | BOZEMAN
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State | MT
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Zip | 59715-4148
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Country | US
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Telephone | 406-586-4559
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Fax |
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Provider Business Mailing Address
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Address Line | 379 HILLSDALE RD
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City | BELGRADE
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State | MT
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Zip | 59714-9377
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Country | US
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Telephone | 715-495-5131
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GREGORY MOOS
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Credential |
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Telephone | 715-495-5131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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