MEDICARE: DR. D. KENT MOBERLY 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
1	1223G0001X	General Practice Dentistry	DE00005527	WA

General Provider Information

NPI Number	:	1215013602
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. D. KENT MOBERLY D.M.D.

Provider Business Mailing Address
First Line	:	3300 W MCGRAW ST
Second Line	:	SUITE 240
City	:	SEATTLE
State	:	WA
Zip	:	98199-3246
Country	:	US
Telephone Number	:	206-283-2400
Fax Number	:	206-283-0385

Provider Business Practice Location Address
First Line	:	3300 W MCGRAW ST
Second Line	:	SUITE 240
City	:	SEATTLE
State	:	WA
Zip	:	98199-3246
Country	:	US
Telephone Number	:	206-283-2400
Fax Number	:	206-283-0385

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	04/22/2011

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