Provider Demographics
NPI:1336241157
Name:MOSHER, ALESHA DIANE (EFODA)
Entity Type:Individual
Prefix:MRS
First Name:ALESHA
Middle Name:DIANE
Last Name:MOSHER
Suffix:
Gender:F
Credentials:EFODA
Other - Prefix:MRS
Other - First Name:ALESHA
Other - Middle Name:DIANE
Other - Last Name:BRINKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EFODA
Mailing Address - Street 1:12611 NE 99TH ST APT Q111
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-2475
Mailing Address - Country:US
Mailing Address - Phone:360-883-5294
Mailing Address - Fax:
Practice Address - Street 1:12711 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6053
Practice Address - Country:US
Practice Address - Phone:360-896-4484
Practice Address - Fax:360-896-4489
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA713126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant