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General NPI Number Information
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NPI Number | 1912167248
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Entity Type | Organization
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Legal Business Name | JOSEPH MOSS DDS & TYLER TEBAY DMD PS
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 1105 4TH AVE E SUITE A
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City | OLYMPIA
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State | WA
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Zip | 98506-4018
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Country | US
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Telephone | 360-357-8075
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Fax | 360-357-3842
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Provider Business Mailing Address
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Address Line | 1105 4TH AVE E SUITE A
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City | OLYMPIA
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State | WA
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Zip | 98506-4018
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Country | US
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Telephone | 360-357-8075
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Fax | 360-357-3842
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Authorized Official
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Title or Position | OFFICE MANAGER/ADMINISTRATOR
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Name | DAWN QUESADA
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Credential |
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Telephone | 360-357-8075
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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 | DE00006116
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License Number State | WA
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