Provider Demographics
NPI:1295914240
Name:MOYA, MARK M (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:M
Last Name:MOYA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23525 GOLDEN SPRINGS DR STE E
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-2175
Mailing Address - Country:US
Mailing Address - Phone:909-861-2211
Mailing Address - Fax:
Practice Address - Street 1:23525 GOLDEN SPRINGS DR STE E
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-2175
Practice Address - Country:US
Practice Address - Phone:909-861-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice