Healthcare Provider Details

I. General information

NPI: 1194663518
Provider Name (Legal Business Name): MOSHER FAMILY DENTISTRY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 6TH AVE W
MONROE WI
53566-1371
US

IV. Provider business mailing address

1001 6TH AVE W
MONROE WI
53566-1371
US

V. Phone/Fax

Practice location:
  • Phone: 608-325-9105
  • Fax:
Mailing address:
  • Phone: 608-325-9105
  • 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: DR. KATIE ROSE MOSHER
Title or Position: DENTIST
Credential: DDS
Phone: 608-325-9105