MEDICARE: DIANA LESKO MOORMAN 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	7639	IN

General Provider Information

NPI Number	:	1659478774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA LESKO MOORMAN DDS

Provider Business Mailing Address
First Line	:	451 E ADAMS ST
Second Line	:
City	:	FRANKLIN
State	:	IN
Zip	:	46131-1825
Country	:	US
Telephone Number	:	317-736-8150
Fax Number	:

Provider Business Practice Location Address
First Line	:	549 PARKVIEW DR
Second Line	:
City	:	NEW WHITELAND
State	:	IN
Zip	:	46184-1365
Country	:	US
Telephone Number	:	317-535-7522
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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