Provider Demographics
NPI:1720726706
Name:RICHARD J. MOSES, III, DMD, PC
Entity type:Organization
Organization Name:RICHARD J. MOSES, III, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-566-3776
Mailing Address - Street 1:397 KUNKEL AVE
Mailing Address - Street 2:
Mailing Address - City:HUMMELSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17036-9337
Mailing Address - Country:US
Mailing Address - Phone:717-566-3776
Mailing Address - Fax:
Practice Address - Street 1:397 KUNKEL AVE
Practice Address - Street 2:
Practice Address - City:HUMMELSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17036-9337
Practice Address - Country:US
Practice Address - Phone:717-566-3776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD J. MOSES, III, DMD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-20
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1275610792Medicaid