Provider Demographics
NPI:1477290948
Name:MARY ELIZABETH MOENSSEN, D.D.S., M.S., P.C.
Entity Type:Organization
Organization Name:MARY ELIZABETH MOENSSEN, D.D.S., M.S., P.C.
Other - Org Name:DEXTER ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MOENSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:734-426-5220
Mailing Address - Street 1:7200 DAN HOEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-4201
Mailing Address - Country:US
Mailing Address - Phone:734-426-5220
Mailing Address - Fax:
Practice Address - Street 1:7200 DAN HOEY RD STE B
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-4201
Practice Address - Country:US
Practice Address - Phone:734-426-5220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty