Provider Demographics
NPI:1144793233
Name:MOYA, YUDIT D (DDS)
Entity Type:Individual
Prefix:
First Name:YUDIT
Middle Name:D
Last Name:MOYA
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 1:17 W CANAL ST N
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-3078
Mailing Address - Country:US
Mailing Address - Phone:561-996-6165
Mailing Address - Fax:561-983-8154
Practice Address - Street 1:17 W CANAL ST N
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-3078
Practice Address - Country:US
Practice Address - Phone:561-996-6165
Practice Address - Fax:561-983-8154
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23899122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist