Provider Demographics
NPI:1033379433
Name:MOSHER, KATIE ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:ROSE
Last Name:MOSHER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WI
Mailing Address - Zip Code:53566-1371
Mailing Address - Country:US
Mailing Address - Phone:608-325-9105
Mailing Address - Fax:608-325-9431
Practice Address - Street 1:1001 6TH AVE W
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WI
Practice Address - Zip Code:53566-1371
Practice Address - Country:US
Practice Address - Phone:608-325-9105
Practice Address - Fax:608-325-9431
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist