Provider Demographics
NPI:1497487318
Name:MOYA, DILLON Z
Entity Type:Individual
Prefix:
First Name:DILLON
Middle Name:Z
Last Name:MOYA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3850 S BOND AVE APT 436
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4836
Mailing Address - Country:US
Mailing Address - Phone:915-345-5387
Mailing Address - Fax:
Practice Address - Street 1:5071 NE 122ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1003
Practice Address - Country:US
Practice Address - Phone:503-255-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38504122300000X, 1223G0001X
ORD11762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice