MEDICARE: DR. RICHARD R MOIST 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	1223E0200X	Endodontics	10431	MO

General Provider Information

NPI Number	:	1740284769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD R MOIST DDS

Provider Business Mailing Address
First Line	:	2122 S STEWART AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2549
Country	:	US
Telephone Number	:	417-881-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 S STEWART AVE
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-2549
Country	:	US
Telephone Number	:	417-881-5155
Fax Number	:

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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