Provider Demographics
NPI:1821155581
Name:MOYES IVERSON DENTAL LLC
Entity Type:Organization
Organization Name:MOYES IVERSON DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:MOYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-475-1999
Mailing Address - Street 1:1770 E 5625 SO
Mailing Address - Street 2:STE 2
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403
Mailing Address - Country:US
Mailing Address - Phone:801-475-1999
Mailing Address - Fax:801-475-1888
Practice Address - Street 1:1770 E 5625 SO
Practice Address - Street 2:STE 2
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403
Practice Address - Country:US
Practice Address - Phone:801-475-1999
Practice Address - Fax:801-475-1888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty