Provider Demographics
NPI:1528004074
Name:MOYES, LAURENCE KENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:KENT
Last Name:MOYES
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 1:2783 MADISON AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-0111
Mailing Address - Country:US
Mailing Address - Phone:801-393-5601
Mailing Address - Fax:801-393-5601
Practice Address - Street 1:2783 MADISON AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-0111
Practice Address - Country:US
Practice Address - Phone:801-393-5601
Practice Address - Fax:801-393-5601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1336821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice