Healthcare Provider Details

I. General information

NPI: 1598078529
Provider Name (Legal Business Name): JAYDE ISMAE NADIA MOXEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 07/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 TOLLAND TPKE
MANCHESTER CT
06042-1679
US

IV. Provider business mailing address

21 TEMPLE ST APT 305
HARTFORD CT
06103-1311
US

V. Phone/Fax

Practice location:
  • Phone: 860-533-7270
  • Fax:
Mailing address:
  • Phone: 804-787-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10296
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: