Healthcare Provider Details

I. General information

NPI: 1518974880
Provider Name (Legal Business Name): PAUL W MOYER DDS,MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W229N1433 WESTWOOD DR SUITE 202
WAUKESHA WI
53186-1171
US

IV. Provider business mailing address

W229N1433 WESTWOOD DR SUITE 202
WAUKESHA WI
53186-1171
US

V. Phone/Fax

Practice location:
  • Phone: 262-544-6115
  • Fax: 262-544-6157
Mailing address:
  • Phone: 262-544-6115
  • Fax: 262-544-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3651
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: