1043320807 NPI number — DR. GEORGE WASHINGTON MOSS III DOS FAGD

Table of content: DR. GEORGE WASHINGTON MOSS III DOS FAGD (NPI 1043320807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043320807 NPI number — DR. GEORGE WASHINGTON MOSS III DOS FAGD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOSS
Provider First Name:
GEORGE
Provider Middle Name:
WASHINGTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
DOS FAGD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043320807
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13843 HWY 105 W
Provider Second Line Business Mailing Address:
#106
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-588-6999
Provider Business Mailing Address Fax Number:
936-588-6998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13843 HWY 105 W
Provider Second Line Business Practice Location Address:
#106
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-588-6999
Provider Business Practice Location Address Fax Number:
936-588-6998
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  10536 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10536 . This is a "DENTIST" identifier . This identifiers is of the category "OTHER".




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