Provider Demographics
NPI:1124427331
Name:MOSER, MINDY MAY (DDS)
Entity type:Individual
Prefix:DR
First Name:MINDY
Middle Name:MAY
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 1:1018 CITY VIEW DR
Mailing Address - Street 2:#4
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76306-5845
Mailing Address - Country:US
Mailing Address - Phone:940-733-6845
Mailing Address - Fax:
Practice Address - Street 1:1414 KEMP BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-2251
Practice Address - Country:US
Practice Address - Phone:940-723-1301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist