Healthcare Provider Details

I. General information

NPI: 1841277407
Provider Name (Legal Business Name): MICHELLE MARIE MOFFA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2005
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

IV. Provider business mailing address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 850-767-3350
  • Fax: 850-872-3353
Mailing address:
  • Phone: 850-747-5599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN21740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: