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NPI Code Detail

MEDICARE: SHUKA MOSHIRI D.M.D.

MEDICARE: SHUKA MOSHIRI D.M.D.
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
11223G0001XGeneral Practice Dentistry2011017340MO

General Provider Information

NPI Number : 1043507692
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHUKA MOSHIRI D.M.D.
Provider Business Mailing Address
First Line : 621 S NEW BALLAS RD STE 10
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8239
Country : US
Telephone Number : 314-251-5775
Fax Number : 314-251-5776
Provider Business Practice Location Address
First Line : 621 S NEW BALLAS RD STE 10
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-8239
Country : US
Telephone Number : 314-251-5775
Fax Number : 314-251-5776
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2011
Last Update Date : 07/05/2011

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