Individual
GREGORY MOOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
515 BROADWAY AVE. NORTH, RED LODGE, MT 59068
(715) 495-5131
Mailing address
PO BOX 663, RED LODGE, MT 59068-0663
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1001314-15
WI
122300000X
Dentist
Primary
11522
MT
Other
Enumeration date
06/27/2016
Last updated
07/01/2016
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