Provider Demographics
NPI:1205833159
Name:MOYER, JEFFERY ORLAND (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:ORLAND
Last Name:MOYER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-1224
Mailing Address - Country:US
Mailing Address - Phone:417-682-5871
Mailing Address - Fax:417-682-6791
Practice Address - Street 1:805 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1224
Practice Address - Country:US
Practice Address - Phone:417-682-5871
Practice Address - Fax:417-682-6791
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO13806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist