Provider Demographics
NPI:1184267841
Name:MOISEY, EUGENE W (PHDHP, RDH)
Entity type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:W
Last Name:MOISEY
Suffix:
Gender:M
Credentials:PHDHP, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S. MARKET ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603
Mailing Address - Country:US
Mailing Address - Phone:570-752-8753
Mailing Address - Fax:
Practice Address - Street 1:107 S. MARKET ST
Practice Address - Street 2:SUITE #2
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603
Practice Address - Country:US
Practice Address - Phone:570-752-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH000079124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist