MEDICARE: DR. CECILIA A MOY 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	122300000X	Dentist	30019186	OH
2	1223P0221X	Pediatric Dentistry	30019186	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	311361540	OTHER	OH	CARE SOURCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	311361540	OTHER	OH	MOLINA

General Provider Information

NPI Number	:	1457447096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CECILIA A MOY DDS

Provider Business Mailing Address
First Line	:	4015 HENDERSON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-2288
Country	:	US
Telephone Number	:	614-451-2023
Fax Number	:

Provider Business Practice Location Address
First Line	:	4072 GANTZ RD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-4816
Country	:	US
Telephone Number	:	614-871-3700
Fax Number	:	614-871-3110

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	04/14/2025

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