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General NPI Number Information
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NPI Number | 1548015910
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Entity Type | Individual
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Provider Name | JAZMIN MOSS
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Gender | Female
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Dates
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Enumeration Date | 04/19/2024
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Last Update Date | 08/05/2025
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Provider Practice Location Address
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Address Line | 601 MS-12
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City | STARKVILLE
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State | MS
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Zip | 39759
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Country | US
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Telephone | 662-270-4054
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Fax |
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Provider Business Mailing Address
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Address Line | 7 CALLE CAREYES
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-6997
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Country | US
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Telephone | 714-943-7718
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Fax |
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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 | 111323
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License Number State | CA
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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 | 111369
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License Number State | MS
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