Provider Demographics
NPI:1912946872
Name:MOSIER, KRISTINE M (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:M
Last Name:MOSIER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 N SENATE BLVD
Practice Address - Street 2:ROOM 1204A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-6793
Practice Address - Fax:317-962-8281
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010577122300000X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000358075OtherANTHEM BCBS
INP00267322OtherRAILROAD MEDICARE
INP00816224OtherRAILROAD MEDICARE
IN200490890Medicaid
INV00376Medicare UPIN
INP00267322OtherRAILROAD MEDICARE
IN959090BBB3Medicare PIN