Active NPI
Shaneka S Marks Moss, D.D.S
- Dentist
- Grand Prairie, TX
National Provider Identifier
1962716399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 25693
- Practice address
- 5103 Magna Carta Blvd
Suite 100
Grand Prairie, TX 75052-5213 - Phone
- (972) 352-6677
- Fax
- (972) 352-6678
- NPI assigned
- Jul 27, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 25693 | TX | Primary |
Addresses
Primary practice location
5103 Magna Carta Blvd
Suite 100
Grand Prairie, TX 75052-5213
Mailing address
5103 Magna Carta Blvd
Suite 100
Grand Prairie, TX 75052-5213
Phone (972) 352-6677
Other names 1
- Dr. Shaneka Moss
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25693 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shaneka Marks Moss DDS PC | Dentist | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379894400000",
"number": "1962716399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5103 MAGNA CARTA BLVD",
"address_2": "SUITE 100",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750525213",
"telephone_number": "972-352-6677",
"fax_number": "972-352-6678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5103 MAGNA CARTA BLVD",
"address_2": "SUITE 100",
"city": "GRAND PRAIRIE",
"state": "TX",
"postal_code": "750525213",
"telephone_number": "972-352-6677",
"fax_number": "972-352-6678"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARKS MOSS",
"first_name": "SHANEKA",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-27",
"last_updated": "2013-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "25693",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "SHANEKA",
"last_name": "MOSS",
"prefix": "DR.",
"credential": "D.D.S.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Grand Prairie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.