Healthcare Provider Details

I. General information

NPI: 1144793233
Provider Name (Legal Business Name): YUDIT D MOYA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W CANAL ST N
BELLE GLADE FL
33430-3078
US

IV. Provider business mailing address

17 W CANAL ST N
BELLE GLADE FL
33430-3078
US

V. Phone/Fax

Practice location:
  • Phone: 561-996-6165
  • Fax: 561-983-8154
Mailing address:
  • Phone: 561-996-6165
  • Fax: 561-983-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN23899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: