MEDICARE: DR. KRISTINE M MOSIER DMD

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	12010577	IN
2	1223X0008X	Oral and Maxillofacial Radiology Dentistry	12010577	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00267322	OTHER	IN	RAILROAD MEDICARE
3	P00816224	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000358075	OTHER	IN	ANTHEM BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912946872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINE M MOSIER DMD

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N SENATE BLVD
Second Line	:	ROOM 1204A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1239
Country	:	US
Telephone Number	:	317-962-6793
Fax Number	:	317-962-8281

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	12/18/2020

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