Provider Demographics
NPI:1306151683
Name:MOSSER, DAVID RUSSEL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSEL
Last Name:MOSSER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2202
Mailing Address - Country:US
Mailing Address - Phone:317-773-3888
Mailing Address - Fax:
Practice Address - Street 1:140 N 10TH ST
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2202
Practice Address - Country:US
Practice Address - Phone:317-773-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011525A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist