Individual
DR. STACY DAVIS MOORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
30.020350
OH
1223G0001X
General Practice Dentistry
OH02350
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0340634
—
OH
01
—
803310
UNITED CONCORDIA PROVIDER
OH
Enumeration date
07/26/2005
Last updated
04/20/2023
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