Provider Demographics
NPI:1992941538
Name:MOSES, TERRY JAMES I
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:JAMES
Last Name:MOSES
Suffix:I
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:JAMES
Other - Last Name:MOSES
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:50 FOX RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-8391
Mailing Address - Country:US
Mailing Address - Phone:717-838-2242
Mailing Address - Fax:717-838-2242
Practice Address - Street 1:50 FOX RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-8391
Practice Address - Country:US
Practice Address - Phone:717-838-2242
Practice Address - Fax:717-838-2242
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-04
Last Update Date:2009-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021014L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist