Provider Demographics
NPI:1972986602
Name:MOSER, CRYSTAL (RDH)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MOSER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2612 W COVER DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-5469
Mailing Address - Country:US
Mailing Address - Phone:417-818-3397
Mailing Address - Fax:
Practice Address - Street 1:2612 W COVER DR
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-5469
Practice Address - Country:US
Practice Address - Phone:417-818-3397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015018519124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist