MEDICARE: JEFFREY V MOFFETT D.M.D P.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN15450	FL

General Provider Information

NPI Number	:	1033363197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY V MOFFETT D.M.D P.A

Provider Business Mailing Address
First Line	:	13136 VAIL RIDGE DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7187
Country	:	US
Telephone Number	:	813-677-3331
Fax Number	:	813-677-3336

Provider Business Practice Location Address
First Line	:	13136 VAIL RIDGE DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7187
Country	:	US
Telephone Number	:	813-677-3331
Fax Number	:	813-677-3336

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY VICTOR MOFFETT
Credential	:	D.M.D
Telephone Number	:	813-677-3331

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	11/14/2008

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