Provider Demographics
NPI:1972607372
Name:KAY C. MOSER, DDS, APDC
Entity type:Organization
Organization Name:KAY C. MOSER, DDS, APDC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-748-4652
Mailing Address - Street 1:416 N. SECOND ST.
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422
Mailing Address - Country:US
Mailing Address - Phone:985-748-4652
Mailing Address - Fax:985-748-7957
Practice Address - Street 1:416 N. SECOND ST.
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422
Practice Address - Country:US
Practice Address - Phone:985-748-4652
Practice Address - Fax:985-748-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1833177Medicaid