Healthcare Provider Details

I. General information

NPI: 1700545480
Provider Name (Legal Business Name): DRS MOSHOS AND REIMELS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 ROCKY RIVER RD
MOORESVILLE NC
28115
US

IV. Provider business mailing address

PO BOX 2249
HUNTERSVILLE NC
28070-2249
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone: 704-978-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AMANDA NOELLE GROESCHEL
Title or Position: DIRECTOR
Credential:
Phone: 704-978-9800