Provider Demographics
NPI:1932169513
Name:MOFFITT, BERT LLOYD (DDS)
Entity Type:Individual
Prefix:
First Name:BERT
Middle Name:LLOYD
Last Name:MOFFITT
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 1:5068 W 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6302
Mailing Address - Country:US
Mailing Address - Phone:303-426-0023
Mailing Address - Fax:303-426-4026
Practice Address - Street 1:5068 W 92ND AVE
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6302
Practice Address - Country:US
Practice Address - Phone:303-426-0023
Practice Address - Fax:303-426-4026
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO05453122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist