Gregory Moos, DDS
Individual provider Active NPI Dentist · Red Lodge, MT
NPI 1285085795 · NPPES record last updated Jul 1, 2016
Key facts
- NPI
- 1285085795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11522 (MT)
- Practice address
- 515 Broadway Ave. North
Red Lodge, MT 59068 - Phone
- (715) 495-5131
- NPI assigned
- Jun 27, 2016
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161117000449 | MT | Order and Referring Only - Dentist |
7517246416 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001314-15 | WI | MD | Dentist |
| 11522 | MT | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gregory J Moos DDS PC | Current | Accepting new patients | |
| Moos Dental of Montana PLLC | Current | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1001314-15 | WI | |
| Dentist | 122300000X | 11522 | MT | Yes |
Addresses
Primary practice location
515 Broadway Ave. North
Red Lodge, MT 59068
Mailing address
PO Box 663
Red Lodge, MT 59068-0663
Other providers in Red Lodge, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.