| Theodore L Moss Dmd Ms Pc | |
|
804 Freeport Rd Sterling IL 61081-3028 | |
| (815) 625-3504 | |
| Not Available |
| Full Name | Theodore L Moss Dmd Ms Pc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 804 Freeport Rd, Sterling, Illinois |
| Authorized Official Name and Position | Theodore Lee Moss (PRESIDENT) |
| Authorized Official Contact | 8472957581 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Theodore L Moss Dmd Ms Pc 677 Forest Hill Rd Lake Forest IL 60045-3127 Ph: (847) 295-7581 | Theodore L Moss Dmd Ms Pc 804 Freeport Rd Sterling IL 61081-3028 Ph: (815) 625-3504 |
| NPI Number | 1265588420 |
|---|---|
| Provider Enumeration Date | 01/28/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265588420 | NPI | - | NPPES |
| 1003057 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 1915769 (Illinois) | Primary |
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