Provider Demographics
NPI:1457835167
Name:MOTUUF, LLC.
Entity Type:Organization
Organization Name:MOTUUF, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-439-5050
Mailing Address - Street 1:3401 DENALI ST STE 201
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4001
Mailing Address - Country:US
Mailing Address - Phone:907-561-8573
Mailing Address - Fax:907-563-6094
Practice Address - Street 1:3401 DENALI ST STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4001
Practice Address - Country:US
Practice Address - Phone:907-561-8573
Practice Address - Fax:907-563-6094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1619613Medicaid