Provider Demographics
NPI:1174092845
Name:MOSES-BOONE, CHANEL Q (DMD)
Entity type:Individual
Prefix:DR
First Name:CHANEL
Middle Name:Q
Last Name:MOSES-BOONE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TOWNSHIP DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29153-7439
Mailing Address - Country:US
Mailing Address - Phone:803-406-5221
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAC-FT. HOOD ATTN: CREDENTIALS
Practice Address - Street 2:BLDG 36000, STE 1048 DARNALL LOOP
Practice Address - City:FT. HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5054
Practice Address - Country:US
Practice Address - Phone:254-287-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice