Provider Demographics
NPI:1063596351
Name:MOSER, JENIFER K (DDS)
Entity type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:K
Last Name:MOSER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 HIGHWAY C
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:MO
Mailing Address - Zip Code:63068-1425
Mailing Address - Country:US
Mailing Address - Phone:573-237-3038
Mailing Address - Fax:573-237-2987
Practice Address - Street 1:1009 HIGHWAY C
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:MO
Practice Address - Zip Code:63068-1425
Practice Address - Country:US
Practice Address - Phone:573-237-3038
Practice Address - Fax:573-237-2987
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0160011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice