Provider Demographics
NPI:1104436138
Name:MOSHER, GEMMA SHIRANI (ADT124/LDH7581)
Entity type:Individual
Prefix:
First Name:GEMMA
Middle Name:SHIRANI
Last Name:MOSHER
Suffix:
Gender:F
Credentials:ADT124/LDH7581
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8960 SPRINGBROOK DR NW STE 150
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-5810
Mailing Address - Country:US
Mailing Address - Phone:763-600-6800
Mailing Address - Fax:763-784-5978
Practice Address - Street 1:8960 SPRINGBROOK DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5852
Practice Address - Country:US
Practice Address - Phone:763-600-6800
Practice Address - Fax:763-784-5978
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNDT124125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist