Provider Demographics
NPI:1093973927
Name:MOELLER, JOY LEA (RDH, COM)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:LEA
Last Name:MOELLER
Suffix:
Gender:F
Credentials:RDH, COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15340 ALBRIGHT ST UNIT 305
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-2528
Mailing Address - Country:US
Mailing Address - Phone:310-454-4044
Mailing Address - Fax:310-454-0391
Practice Address - Street 1:15340 ALBRIGHT ST UNIT 305
Practice Address - Street 2:910 VIA DE LA PAZ #106
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-2528
Practice Address - Country:US
Practice Address - Phone:310-454-4044
Practice Address - Fax:310-454-0391
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8267124Q00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No124Q00000XDental ProvidersDental Hygienist