Healthcare Provider Details

I. General information

NPI: 1902081656
Provider Name (Legal Business Name): THOMAS EDWARD MOYER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 MARKET ST SUITE 226
SAN FRANCISCO CA
94102-5402
US

IV. Provider business mailing address

3874 25TH ST
SAN FRANCISCO CA
94114-3906
US

V. Phone/Fax

Practice location:
  • Phone: 415-621-5471
  • Fax:
Mailing address:
  • Phone: 415-824-3073
  • Fax: 415-824-3073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30830
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.016462
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: