Individual
TRACIE MOYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
5337 W GRANDE MARKET DRIVE, APPLETON, WI 54913-5491
(920) 731-7445
(920) 882-2946
Mailing address
119 N MCCARTHY RD STE S, APPLETON, WI 54913-9111
(920) 731-7445
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
7001063-16
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7001063-16
—
WI
Enumeration date
11/07/2022
Last updated
11/08/2022
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