MEDICARE: ROBERT MOFFETT

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	6927	FL

General Provider Information

NPI Number	:	1285858126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MOFFETT

Provider Business Mailing Address
First Line	:	5150 E BAY DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-5720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 E BAY DR
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33764-5720
Country	:	US
Telephone Number	:	727-535-5583
Fax Number	:

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

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	07/08/2007

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Directions to “ ROBERT MOFFETT ” Practice Location

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