Provider Demographics
NPI:1376983973
Name:MOYA, DIETER JESUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIETER
Middle Name:JESUS
Last Name:MOYA
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 1:7500 SAN FELIPE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1707
Mailing Address - Country:US
Mailing Address - Phone:713-457-6337
Mailing Address - Fax:
Practice Address - Street 1:7500 SAN FELIPE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1707
Practice Address - Country:US
Practice Address - Phone:713-457-6337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX195801223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery