Individual
KEVIN CARROLL MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD MS PLLC
Contact information
Practice address
5320 CORPORATE CENTER LOOP SE, SUITE A, LACEY, WA 98503
(360) 491-7080
(360) 491-7105
Mailing address
5320 CORPORATE CENTER LOOP SE, SUITE A, LACEY, WA 98503
(360) 491-7080
(360) 491-7105
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
0700009204
WA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
0700009204
WA
Other
Enumeration date
04/04/2007
Last updated
09/11/2025
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