Provider Demographics
NPI:1164429783
Name:MOYER, DAVID R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MOYER
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 1:10920 N TATUM BLVD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3097
Mailing Address - Country:US
Mailing Address - Phone:480-991-6922
Mailing Address - Fax:602-595-0732
Practice Address - Street 1:10920 N TATUM BLVD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3097
Practice Address - Country:US
Practice Address - Phone:480-991-6922
Practice Address - Fax:602-595-0732
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-29
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
AZ26431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice