Provider Demographics
NPI:1407875735
Name:MOFFSON, ALLEN MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:MARK
Last Name:MOFFSON
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 1:116 W PLAZA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1124
Mailing Address - Country:US
Mailing Address - Phone:858-755-5168
Mailing Address - Fax:858-755-2265
Practice Address - Street 1:116 W PLAZA ST
Practice Address - Street 2:SUITE A
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1124
Practice Address - Country:US
Practice Address - Phone:858-755-5168
Practice Address - Fax:858-755-2265
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA210381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics