Provider Demographics
NPI:1124040969
Name:MOXLEY, JEFF E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:E
Last Name:MOXLEY
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 1:3663 E SUNSET RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3218
Mailing Address - Country:US
Mailing Address - Phone:702-898-8350
Mailing Address - Fax:702-898-8392
Practice Address - Street 1:3663 E SUNSET RD
Practice Address - Street 2:SUITE 403
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-3218
Practice Address - Country:US
Practice Address - Phone:702-898-8350
Practice Address - Fax:702-898-8392
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2886 (S2-25)1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV30182Medicare ID - Type Unspecified
NVU66911Medicare UPIN