Provider Demographics
NPI:1861884777
Name:ALLEN J MOSES DDS LTD.
Entity type:Organization
Organization Name:ALLEN J MOSES DDS LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-993-0430
Mailing Address - Street 1:233 S WACKER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-7147
Mailing Address - Country:US
Mailing Address - Phone:312-993-0430
Mailing Address - Fax:312-993-9140
Practice Address - Street 1:233 S WACKER DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60606-6423
Practice Address - Country:US
Practice Address - Phone:312-993-0430
Practice Address - Fax:312-993-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty