MEDICARE: DANIEL P. MOYLAN D.D.S. PLLC

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	2901019359	MI

General Provider Information

NPI Number	:	1528210176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANIEL P. MOYLAN D.D.S. PLLC

Provider Business Mailing Address
First Line	:	877 M-32 EAST
Second Line	:
City	:	GAYLORD
State	:	MI
Zip	:	49735
Country	:	US
Telephone Number	:	989-732-1213
Fax Number	:	989-731-0321

Provider Business Practice Location Address
First Line	:	877 E M 32
Second Line	:
City	:	GAYLORD
State	:	MI
Zip	:	49735-9701
Country	:	US
Telephone Number	:	989-732-1213
Fax Number	:	989-731-0321

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL P MOYLAN
Credential	:	DDS
Telephone Number	:	989-732-1213

Provider Enumeration Date	:	10/15/2008
Last Update Date	:	10/15/2008

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