Basic Information
Provider Information
NPI: 1033557202
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOSER
FirstName: LINDSAY
MiddleName: BROOKE
NamePrefix:  
NameSuffix:  
Credential: R.D.H
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11488 COUNTY ROAD 41
Address2:  
City: HUDSON
State: CO
PostalCode: 806429618
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 11488 COUNTY ROAD 41
Address2:  
City: HUDSON
State: CO
PostalCode: 806429618
CountryCode: US
TelephoneNumber: 3034720934
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/11/2013
LastUpdateDate: 06/11/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
124Q00000X904097COY Dental ProvidersDental Hygienist 

No ID Information.


Home