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General NPI Number Information
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NPI Number | 1033363197
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Entity Type | Organization
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Legal Business Name | JEFFREY V MOFFETT D.M.D P.A
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Dates
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Enumeration Date | 11/14/2008
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Last Update Date | 11/14/2008
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Provider Practice Location Address
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Address Line | 13136 VAIL RIDGE DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-7187
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Country | US
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Telephone | 813-677-3331
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Fax | 813-677-3336
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Provider Business Mailing Address
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Address Line | 13136 VAIL RIDGE DR
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City | RIVERVIEW
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State | FL
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Zip | 33579-7187
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Country | US
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Telephone | 813-677-3331
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Fax | 813-677-3336
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY VICTOR MOFFETT
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Credential | D.M.D
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Telephone | 813-677-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DN15450
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License Number State | FL
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