Healthcare Provider Details

I. General information

NPI: 1114657574
Provider Name (Legal Business Name): AMY MOYER DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N 6TH ST STE 310
ALLENTOWN PA
18101-1403
US

IV. Provider business mailing address

400 N 17TH ST STE 300
ALLENTOWN PA
18104-5052
US

V. Phone/Fax

Practice location:
  • Phone: 484-224-0777
  • Fax: 610-969-2432
Mailing address:
  • Phone: 610-969-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: