Healthcare Provider Details

I. General information

NPI: 1538249040
Provider Name (Legal Business Name): REUBEN TAFADZWA MOYANA D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 SPORTSMAN DR
PHENIX CITY AL
36867-5402
US

IV. Provider business mailing address

129 LEE ROAD 2200
SMITHS STATION AL
36877-3388
US

V. Phone/Fax

Practice location:
  • Phone: 334-297-5890
  • Fax: 334-298-2725
Mailing address:
  • Phone: 205-991-7398
  • Fax: 334-298-2725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5344
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: