MEDICARE: DR. JANELLE MOSER-HARRIS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	18123	TX
2	1223G0001X	General Practice Dentistry	18123	TX

General Provider Information

NPI Number	:	1598812125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANELLE MOSER-HARRIS DDS

Provider Business Mailing Address
First Line	:	2504 LAKE AUSTIN BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-4455
Country	:	US
Telephone Number	:	512-474-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	2504 LAKE AUSTIN BLVD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-4455
Country	:	US
Telephone Number	:	512-474-5233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	12/18/2009

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