Provider Demographics
NPI:1114076981
Name:MOYNIHAN, ROGER PATRICK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PATRICK
Last Name:MOYNIHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 MISSION AVE
Mailing Address - Street 2:STE 9
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7802
Mailing Address - Country:US
Mailing Address - Phone:760-439-5515
Mailing Address - Fax:760-439-2767
Practice Address - Street 1:3935 MISSION AVE
Practice Address - Street 2:STE 9
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7802
Practice Address - Country:US
Practice Address - Phone:760-439-5515
Practice Address - Fax:760-439-2767
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice