Provider Demographics
NPI:1477608172
Name:MOFFITT, ZACHARY DODE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:DODE
Last Name:MOFFITT
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 1:201 S BERRY RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-5412
Mailing Address - Country:US
Mailing Address - Phone:405-360-3800
Mailing Address - Fax:405-321-5758
Practice Address - Street 1:201 S BERRY RD
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-5412
Practice Address - Country:US
Practice Address - Phone:405-360-9800
Practice Address - Fax:405-321-5758
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6 59151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice