Provider Demographics
NPI:1801945779
Name:ROGER P. MOYNIHAN AND AMY JESSEL MOYNIHAN
Entity type:Organization
Organization Name:ROGER P. MOYNIHAN AND AMY JESSEL MOYNIHAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MOYNIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-439-5515
Mailing Address - Street 1:3935 MISSION AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92058-7802
Mailing Address - Country:US
Mailing Address - Phone:760-439-5515
Mailing Address - Fax:760-439-2767
Practice Address - Street 1:3935 MISSION AVE STE 9
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92058-7802
Practice Address - Country:US
Practice Address - Phone:760-439-5515
Practice Address - Fax:760-439-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty