Healthcare Provider Details

I. General information

NPI: 1356895973
Provider Name (Legal Business Name): HEATHER MOYLAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ALEXANDRIA ORTHODONTICS 1216 MACARTHUR DR.
ALEXANDRIA LA
71303
US

IV. Provider business mailing address

1216 MACARTHUR DR.
ALEXANDRIA LA
71303
US

V. Phone/Fax

Practice location:
  • Phone: 504-909-0601
  • Fax:
Mailing address:
  • Phone: 504-909-0601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0442000276
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: