Provider Demographics
NPI:1386710259
Name:MOSIER DENTAL ASSOCIATES
Entity type:Organization
Organization Name:MOSIER DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NOLTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-277-7786
Mailing Address - Street 1:1816 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310
Mailing Address - Country:US
Mailing Address - Phone:515-277-7786
Mailing Address - Fax:515-277-3576
Practice Address - Street 1:1816 BEAVER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310
Practice Address - Country:US
Practice Address - Phone:515-277-7986
Practice Address - Fax:515-277-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA68821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty