Provider Demographics
NPI:1073173050
Name:MOXLEY, MARIAH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:
Last Name:MOXLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15455 E 13TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67230-7572
Mailing Address - Country:US
Mailing Address - Phone:316-304-8884
Mailing Address - Fax:
Practice Address - Street 1:900 N TYLER RD STE 2
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3249
Practice Address - Country:US
Practice Address - Phone:316-722-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61626122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist