Provider Demographics
NPI:1477586485
Name:MOFFITT, ALICE EVELYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:EVELYN
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E 11TH AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3621
Mailing Address - Country:US
Mailing Address - Phone:541-345-3222
Mailing Address - Fax:541-342-7554
Practice Address - Street 1:655 E 11TH AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3621
Practice Address - Country:US
Practice Address - Phone:541-345-3222
Practice Address - Fax:541-342-7554
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD62901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR051511Medicare ID - Type Unspecified