Provider Demographics
NPI:1609564756
Name:DE MOYA, MARIA VALENTINA (DDS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VALENTINA
Last Name:DE MOYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4324 SW 121ST LN APT 205
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3741
Mailing Address - Country:US
Mailing Address - Phone:929-334-5364
Mailing Address - Fax:
Practice Address - Street 1:1240 N UNIVERSITY DR STE B
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4721
Practice Address - Country:US
Practice Address - Phone:954-916-9060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN283951223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program