Healthcare Provider Details

I. General information

NPI: 1306944897
Provider Name (Legal Business Name): STEPHEN JEFFREY MOY D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

443 JOAQUIN AVE
SAN LEANDRO CA
94577-4902
US

IV. Provider business mailing address

443 JOAQUIN AVE
SAN LEANDRO CA
94577-4902
US

V. Phone/Fax

Practice location:
  • Phone: 510-351-4030
  • Fax: 510-351-5503
Mailing address:
  • Phone: 510-351-4030
  • Fax: 510-351-5503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: