MEDICARE: DR. JOHN R. MOSER 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	3071-015	WI

General Provider Information

NPI Number	:	1265596464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN R. MOSER DDS

Provider Business Mailing Address
First Line	:	219 N MILWAUKEE ST FL 5
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-5818
Country	:	US
Telephone Number	:	414-273-9800
Fax Number	:	414-273-9807

Provider Business Practice Location Address
First Line	:	219 N MILWAUKEE ST FL 5
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-5818
Country	:	US
Telephone Number	:	414-273-9800
Fax Number	:	414-273-9807

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

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	07/08/2007

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