Provider Demographics
NPI:1063057552
Name:ROBERT B. MOSS, JR., P.C.
Entity type:Organization
Organization Name:ROBERT B. MOSS, JR., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:229-432-2103
Mailing Address - Street 1:1600 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-3461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3461
Practice Address - Country:US
Practice Address - Phone:229-432-2103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty