Provider Demographics
NPI:1154544419
Name:MOSS, BOYD BLOIS (DMD)
Entity type:Individual
Prefix:
First Name:BOYD
Middle Name:BLOIS
Last Name:MOSS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SOARING GULLS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-2198
Mailing Address - Country:US
Mailing Address - Phone:702-647-4438
Mailing Address - Fax:702-656-6488
Practice Address - Street 1:3200 SOARING GULLS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-2198
Practice Address - Country:US
Practice Address - Phone:702-647-4438
Practice Address - Fax:702-656-6488
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist