Provider Demographics
NPI:1033363197
Name:JEFFREY V MOFFETT D.M.D P.A
Entity Type:Organization
Organization Name:JEFFREY V MOFFETT D.M.D P.A
Other - Org Name:MOFFETT ORAL SURGERY AND DENTAL IMPLANT CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-677-3331
Mailing Address - Street 1:13136 VAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7187
Mailing Address - Country:US
Mailing Address - Phone:813-677-3331
Mailing Address - Fax:813-677-3336
Practice Address - Street 1:13136 VAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7187
Practice Address - Country:US
Practice Address - Phone:813-677-3331
Practice Address - Fax:813-677-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-14
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty