Provider Demographics
NPI:1477740611
Name:MOYA FAMILY DENTISTRY INC
Entity Type:Organization
Organization Name:MOYA FAMILY DENTISTRY INC
Other - Org Name:MOYA FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-337-6834
Mailing Address - Street 1:3630 SE MILITARY DR
Mailing Address - Street 2:114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223
Mailing Address - Country:US
Mailing Address - Phone:210-337-6834
Mailing Address - Fax:210-337-6551
Practice Address - Street 1:3630 SE MILITARY DR
Practice Address - Street 2:114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223
Practice Address - Country:US
Practice Address - Phone:210-337-6834
Practice Address - Fax:210-337-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20527122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188970101Medicaid