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Organization
MOFFITT DENTAL CENTER
Active
Organization
MOFFITT DENTAL CENTER
Active
Other names
Michael W. Moffitt DDS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL WALTER MOFFITT DDS (OWNER/DOCTOR)
(515) 448-4852
Entity
Organization
Contact information
Practice address
422 W BROADWAY ST, EAGLE GROVE, IA 50533-1704
(515) 448-4852
(515) 448-3533
Mailing address
422 W BROADWAY ST, EAGLE GROVE, IA 50533-1704
(515) 448-4852
(515) 448-3533
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6102
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010720525
AMERICAN DENTAL ASSOCIATION
IA
05
—
0148007
—
IA
01
—
14800
WELLMARK BLUE CROSS/BLUE SHIELD
IA
01
—
1613
AMERICAN COLLEGE OF PROSTHODONTICS
IA
Enumeration date
05/20/2008
Last updated
05/20/2008
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