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General NPI Number Information
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NPI Number | 1033132618
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Entity Type | Individual
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Provider Name | JOHN MILLEN MOFFAT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 23111 VENTURA BLVD SUITE 102
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-1103
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Country | US
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Telephone | 818-225-0041
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Fax |
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Provider Business Mailing Address
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Address Line | 5918 RAINBOW HILL RD
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4644
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Country | US
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Telephone | 818-707-9288
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DP032976
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License Number State | CA
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