Provider Demographics
NPI:1982820452
Name:MOYNIHAN, MICHAEL FREDERICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:MOYNIHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 MAIN STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757
Mailing Address - Country:US
Mailing Address - Phone:508-473-8000
Mailing Address - Fax:508-473-5754
Practice Address - Street 1:258 MAIN STREET
Practice Address - Street 2:SUITE 304
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757
Practice Address - Country:US
Practice Address - Phone:508-473-8000
Practice Address - Fax:508-473-5754
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189981223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0279528Medicare ID - Type Unspecified