Individual
DR. WALTER CARL MOSES III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
202 W PARK AVE, GREENWOOD, MS 38930-3009
(662) 219-0044
(662) 219-0045
Mailing address
622 COUNTY ROAD 190, GREENWOOD, MS 38930-6980
(662) 299-0270
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
3793-15
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07720764
—
MS
Enumeration date
03/24/2015
Last updated
10/15/2019
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