MEDICARE: PATRICIA ANN MOSS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0401006130	VA

General Provider Information

NPI Number	:	1124109772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA ANN MOSS D.D.S.

Provider Business Mailing Address
First Line	:	216 OVERLOOK ROAD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-8511
Country	:	US
Telephone Number	:	804-282-6257
Fax Number	:

Provider Business Practice Location Address
First Line	:	6714 PATTERSON AVE
Second Line	:	SUITE 201
City	:	RICHMOND
State	:	VA
Zip	:	23226-3432
Country	:	US
Telephone Number	:	804-282-3197
Fax Number	:	804-285-4634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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