MEDICARE: MRS. JOAN A MOSLEY-HOUSE 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	1223G0001X	General Practice Dentistry	DS027135L	PA

General Provider Information

NPI Number	:	1043349616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN A MOSLEY-HOUSE DDS

Provider Business Mailing Address
First Line	:	309 HOLLY LN
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-5422
Country	:	US
Telephone Number	:	507-388-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	7332 BRENTWOOD RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-2215
Country	:	US
Telephone Number	:	215-473-5453
Fax Number	:	215-473-2363

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	10/18/2023

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