Active NPI
Kevin Carroll Moss, DMD MS PLLC
- Orthodontics and Dentofacial Orthopedics Dentistry
- Lacey, WA
National Provider Identifier
1043332844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 0700009204
- Practice address
- 5320 Corporate Center Loop SE
Suite a
Lacey, WA 98503 - Phone
- (360) 491-7080
- Fax
- (360) 491-7105
- NPI assigned
- Apr 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0700009204 | WA | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 0700009204 | WA | Primary |
Addresses
Primary practice location
5320 Corporate Center Loop SE
Suite a
Lacey, WA 98503
Mailing address
5320 Corporate Center Loop SE
Suite a
Lacey, WA 98503
Phone (360) 491-7080
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0700009204 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matthew D Wall DDS MSD PLLC | Orthodontics and Dentofacial Orthopedics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Orthodontics and Dentofacial Orthopedics Dentistry
- Lacey, WA
- NPI 1962888636
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1043332844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5320 CORPORATE CENTER LOOP SE",
"address_2": "SUITE A",
"city": "LACEY",
"state": "WA",
"postal_code": "98503",
"telephone_number": "360-491-7080",
"fax_number": "360-491-7105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5320 CORPORATE CENTER LOOP SE",
"address_2": "SUITE A",
"city": "LACEY",
"state": "WA",
"postal_code": "98503",
"telephone_number": "360-491-7080",
"fax_number": "360-491-7105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "KEVIN",
"middle_name": "CARROLL",
"credential": "DMD MS PLLC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-04",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "0700009204",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "WA",
"license": "0700009204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lacey, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.