Healthcare Provider Details

I. General information

NPI: 1346225554
Provider Name (Legal Business Name): THOMAS D MOYE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 LABORATORY RD
OAK RIDGE TN
37830-6802
US

IV. Provider business mailing address

420 LABORATORY RD
OAK RIDGE TN
37830-6802
US

V. Phone/Fax

Practice location:
  • Phone: 865-482-1319
  • Fax: 865-481-3067
Mailing address:
  • Phone: 865-482-1319
  • Fax: 865-481-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDS0000003175
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: