Theodore Lee Moss, D.M.D.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

1915769 Issued in IL

Practice address

804 Freeport Rd
Sterling, IL 61081-3028

Phone

(815) 625-3504

NPI assigned

Jan 28, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Theodore L Moss DMD Ms PC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Sterling, IL
  • NPI 1265588420
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366598526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "677 FOREST HILL RD",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600453127",
            "telephone_number": "847-295-7581",
            "fax_number": "847-295-7582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 FREEPORT RD",
            "city": "STERLING",
            "state": "IL",
            "postal_code": "610813028",
            "telephone_number": "815-625-3504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOSS",
        "first_name": "THEODORE",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "1915769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003057",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark Moran, PAC
• Jessica Nicole Moreno
• Kristine M. Morland-Schultz, APN
• Jane Morris, CNP
• Mark Morris, LCSW
• Landon Mouritsen
• Ms Sterling Inc (Medicine Shoppe)
• Myers Counseling L.L.C. (Margo Myers & Associates)
• Margaret H Myers, MSW, LCSW
• Katie Elizabeth Nauman

• Orthodontics and Dentofacial Orthopedics Dentistry in Sterling, IL
• Providers in Sterling, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.