Individual
DR. J RANDALL MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
8660 W EMERALD ST, SUITE 152, BOISE, ID 83704-4825
(208) 323-2294
(208) 323-2299
Mailing address
8660 W EMERALD ST, SUITE 152, BOISE, ID 83704-4825
(208) 323-2294
(208) 323-2299
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3281
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002650900
—
ID
Enumeration date
12/08/2006
Last updated
10/01/2009
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