MEDICARE: DR. DANIEL RAY 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	15649	TX

General Provider Information

NPI Number	:	1255405171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL RAY MOSS D.D.S.

Provider Business Mailing Address
First Line	:	2403 INDIAN CAMP TRL
Second Line	:
City	:	COPPERAS COVE
State	:	TX
Zip	:	76522-3987
Country	:	US
Telephone Number	:	254-518-5133
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 W HIGHWAY 190
Second Line	:
City	:	COPPERAS COVE
State	:	TX
Zip	:	76522-3886
Country	:	US
Telephone Number	:	254-542-5750
Fax Number	:	254-542-4832

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/08/2007

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