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General NPI Number Information
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NPI Number | 1043982093
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Entity Type | Organization
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Legal Business Name | THOMAS K MOE DDS INC
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 906 S SUNSET AVE STE 103
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City | WEST COVINA
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State | CA
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Zip | 91790-3400
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Country | US
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Telephone | 626-241-6817
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Fax | 626-708-0052
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Provider Business Mailing Address
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Address Line | 1237 S 9TH AVE
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City | ARCADIA
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State | CA
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Zip | 91006-4422
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Country | US
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Telephone | 626-241-6817
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Fax | 626-708-0052
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS K MOE
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Credential | DDS
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Telephone | 626-241-6817
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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