Provider Demographics
NPI:1871847079
Name:DAVID R. MOSSER, DDS, LLC
Entity Type:Organization
Organization Name:DAVID R. MOSSER, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-773-3888
Mailing Address - Street 1:140 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2202
Mailing Address - Country:US
Mailing Address - Phone:317-773-3888
Mailing Address - Fax:317-773-3888
Practice Address - Street 1:140 N 10TH ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2202
Practice Address - Country:US
Practice Address - Phone:317-773-3888
Practice Address - Fax:317-773-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120115251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty