Provider Demographics
NPI:1639629272
Name:MOA, ANTONIA (DDS)
Entity Type:Individual
Prefix:
First Name:ANTONIA
Middle Name:
Last Name:MOA
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 1:3611 W 5TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6436
Mailing Address - Country:US
Mailing Address - Phone:805-985-1800
Mailing Address - Fax:805-984-0598
Practice Address - Street 1:3611 W 5TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6436
Practice Address - Country:US
Practice Address - Phone:805-985-1800
Practice Address - Fax:805-984-0598
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1008751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice