Provider Demographics
NPI:1588800767
Name:MOFFATT, JOHN HAROLD JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HAROLD
Last Name:MOFFATT
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PEGGY
Other - Middle Name:ELIZABETH
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5809 CITRUS BLVD. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:HARAHAN
Mailing Address - State:LA
Mailing Address - Zip Code:70123
Mailing Address - Country:US
Mailing Address - Phone:504-733-8551
Mailing Address - Fax:
Practice Address - Street 1:5809 CITRUS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-1690
Practice Address - Country:US
Practice Address - Phone:504-733-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice