Provider Demographics
NPI:1518974880
Name:MOYER, PAUL W (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:W
Last Name:MOYER
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:W229N1433 WESTWOOD DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1171
Mailing Address - Country:US
Mailing Address - Phone:262-544-6115
Mailing Address - Fax:262-544-6157
Practice Address - Street 1:W229N1433 WESTWOOD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1171
Practice Address - Country:US
Practice Address - Phone:262-544-6115
Practice Address - Fax:262-544-6157
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI36511223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics