MEDICARE: MICHAEL ARNOLD 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	21392	CA

General Provider Information

NPI Number	:	1750406674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ARNOLD MOSS D.D.S.

Provider Business Mailing Address
First Line	:	17295 HIWAY 101 N
Second Line	:
City	:	SMITH RIVER
State	:	CA
Zip	:	95567-9406
Country	:	US
Telephone Number	:	707-487-8700
Fax Number	:	707-487-3700

Provider Business Practice Location Address
First Line	:	17295 HIWAY 101 N
Second Line	:
City	:	SMITH RIVER
State	:	CA
Zip	:	95567-9406
Country	:	US
Telephone Number	:	707-487-8700
Fax Number	:	707-487-3700

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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