Provider Demographics
NPI:1235682535
Name:REUBEN MOYANA DMD, PC
Entity Type:Organization
Organization Name:REUBEN MOYANA DMD, PC
Other - Org Name:FORT MITCHELL DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:REUBEN
Authorized Official - Middle Name:TAFADZWA
Authorized Official - Last Name:MOYANA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-855-3300
Mailing Address - Street 1:129 LEE ROAD 2200
Mailing Address - Street 2:
Mailing Address - City:SMITHS STATION
Mailing Address - State:AL
Mailing Address - Zip Code:36877-3388
Mailing Address - Country:US
Mailing Address - Phone:334-855-3300
Mailing Address - Fax:
Practice Address - Street 1:1095 HIGHWAY 165
Practice Address - Street 2:SUITE D
Practice Address - City:FORT MITCHELL
Practice Address - State:AL
Practice Address - Zip Code:36856
Practice Address - Country:US
Practice Address - Phone:334-855-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5344261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental