Provider Demographics
NPI:1427287432
Name:MOSES, STEPHEN BRENT (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRENT
Last Name:MOSES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 FIRST COLONIAL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3000
Mailing Address - Country:US
Mailing Address - Phone:757-496-0993
Mailing Address - Fax:757-496-8137
Practice Address - Street 1:1000 FIRST COLONIAL RD STE 104
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3000
Practice Address - Country:US
Practice Address - Phone:757-496-0993
Practice Address - Fax:757-496-8137
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL758122300000X
VA0401412696122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist