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NPI Code Detail

MEDICARE: REUBEN MOYANA DMD, PC

MEDICARE: REUBEN MOYANA DMD, PC
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
1261QD0000XDental Clinic/Center5344AL

General Provider Information

NPI Number : 1235682535
Entity Type Code : Organization
Provider Name (Legal Business Name) : REUBEN MOYANA DMD, PC
Provider Business Mailing Address
First Line : 129 LEE ROAD 2200
Second Line :
City : SMITHS STATION
State : AL
Zip : 36877-3388
Country : US
Telephone Number : 334-855-3300
Fax Number :
Provider Business Practice Location Address
First Line : 1095 HIGHWAY 165
Second Line : SUITE D
City : FORT MITCHELL
State : AL
Zip : 36856
Country : US
Telephone Number : 334-855-3300
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. REUBEN TAFADZWA MOYANA
Credential : D.M.D
Telephone Number : 334-855-3300
Provider Enumeration Date : 08/03/2016
Last Update Date : 08/03/2016

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