Theodore L Moss Dmd Ms Pc

NPI 1265588420 - Dentist - 1223X0400X

NPI Details
NPI 1265588420
Enumeration Date 01/28/2007
Last Updated 07/08/2007
Entity Type Healthcare Provider
Active Over 9 years ago
Authorized Information
Name THEODORE LEE THEODORE
Position PRESIDENT
Phone (815) 625-3504
Fax
Practice Location
804 FREEPORT RD
STERLING IL, 61081-3028, US
Phone (815) 625-3504
Fax
Business Location
677 FOREST HILL RD
LAKE FOREST IL, 60045-3127, US
Phone (847) 295-7581
Fax
Toxanomy
Taxonomy Code 1223X0400X
License State Illinois
License Number 1915769
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According to our database, Theodore L Moss Dmd Ms Pc NPI is 1265588420, taxonomy code is 1223X0400X and license number is 1915769, license state is located at Illinois. Theodore L Moss Dmd Ms Pc physically located at 804 Freeport Rd, Sterling IL, 61081-3028. NPI Number 1033115704 has the healthcare provider type.

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1265588420 NPI number is provided on an as is basis without warranty of any kind. 1265588420 is maintained by the National Plan & Provider Enumeration System. The contents of Theodore L Moss Dmd Ms Pc are for informational purposes only.