Healthcare Provider Details

I. General information

NPI: 1457447096
Provider Name (Legal Business Name): CECILIA A MOY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4072 GANTZ RD
GROVE CITY OH
43123-4816
US

IV. Provider business mailing address

4015 HENDERSON RD
COLUMBUS OH
43220-2288
US

V. Phone/Fax

Practice location:
  • Phone: 614-871-3700
  • Fax: 614-871-3110
Mailing address:
  • Phone: 614-451-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number30019186
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number30019186
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: