# MOSS DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962806331
- **Authorized official:** MRS. SHELLEY J GRIFFIN (OFFICE MANAGER)
- **Authorized official phone:** (307) 857-2020

## Contact information

- **Practice address:** 203 E MAIN STREET, SUITE 205, RIVERTON, WY 82501
- **Practice address phone:** (307) 857-2020
- **Practice address fax:** (307) 857-2727
- **Mailing address:** 203 E MAIN STREET, SUITE 205, RIVERTON, WY 82501
- **Mailing address phone:** (307) 857-2020
- **Mailing address fax:** (307) 857-2727

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 1220 | WY | Yes |

## Other

- **Enumeration date:** 10/14/2014
- **Last updated:** 10/14/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 127527500 | — | WY |