Provider Demographics
NPI:1598812125
Name:MOSER-HARRIS, JANELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANELLE
Middle Name:
Last Name:MOSER-HARRIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:MOSER-HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2504 LAKE AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4455
Mailing Address - Country:US
Mailing Address - Phone:512-474-5233
Mailing Address - Fax:
Practice Address - Street 1:2504 LAKE AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4455
Practice Address - Country:US
Practice Address - Phone:512-474-5233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18123122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice