Healthcare Provider Details

I. General information

NPI: 1881684587
Provider Name (Legal Business Name): DAVID J MOYER DDS,MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LONG CREEK DR SUITE B
SOUTH PORTLAND ME
04106-2425
US

IV. Provider business mailing address

20 LONG CREEK DR SUITE B
SOUTH PORTLAND ME
04106-2425
US

V. Phone/Fax

Practice location:
  • Phone: 207-772-4063
  • Fax: 207-772-8641
Mailing address:
  • Phone: 207-772-4063
  • Fax: 207-772-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12684
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: