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General NPI Number Information
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NPI Number | 1457571523
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Entity Type | Individual
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Provider Name | MARK ANDREW MOATS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 481 KLUTEY PARK PLAZA DR
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City | HENDERSON
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State | KY
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Zip | 42420-3347
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Country | US
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Telephone | 270-826-2677
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Fax | 270-826-8112
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Provider Business Mailing Address
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Address Line | 481 KLUTEY PARK PLAZA DR
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City | HENDERSON
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State | KY
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Zip | 42420-3347
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Country | US
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Telephone | 270-826-2677
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Fax | 270-826-8112
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6871
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License Number State | KY
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