Provider Demographics
NPI:1245205277
Name:MOYER, IRA NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:NICHOLAS
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 1:10184 W BELLEVIEW AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-1764
Mailing Address - Country:US
Mailing Address - Phone:303-973-4424
Mailing Address - Fax:303-973-4427
Practice Address - Street 1:10184 W BELLEVIEW AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-1764
Practice Address - Country:US
Practice Address - Phone:303-973-4424
Practice Address - Fax:303-973-4427
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO49781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02049781Medicaid