Individual
DR. RYAN C MOFFAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
114 E 12450 S, SUITE 200, DRAPER, UT 84020
(801) 495-1610
(801) 495-1631
Mailing address
PO BOX 830, DRAPER, UT 84020
(801) 495-1610
(801) 495-1631
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
5832460
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1749089
UNITED CONCORDIA
—
01
—
58324609900001
BLUE CROSS
—
01
—
960296
AHCCCS
AZ
Enumeration date
08/04/2006
Last updated
07/08/2007
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