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General NPI Number Information
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NPI Number | 1598078529
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Entity Type | Individual
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Provider Name | JAYDE ISMAE NADIA MOXEY DDS
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Gender | Female
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 07/19/2010
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Provider Practice Location Address
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Address Line | 1131 TOLLAND TPKE
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City | MANCHESTER
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State | CT
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Zip | 06042-1679
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Country | US
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Telephone | 860-533-7270
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Fax |
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Provider Business Mailing Address
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Address Line | 21 TEMPLE ST APT 305
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City | HARTFORD
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State | CT
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Zip | 06103-1311
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Country | US
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Telephone | 804-787-3181
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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 | 10296
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License Number State | CT
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