Provider Demographics
NPI:1346368354
Name:MOATS, MICHAEL E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:MOATS
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 1:135 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-8213
Mailing Address - Country:US
Mailing Address - Phone:847-279-1440
Mailing Address - Fax:847-279-1450
Practice Address - Street 1:135 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-8213
Practice Address - Country:US
Practice Address - Phone:847-279-1440
Practice Address - Fax:847-279-1450
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0159421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice