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Individual

SHAWN MOFFETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
72ND MDG, 7050 AIR DEPOT BLVD, TINKER AFB, OK 73145
(405) 582-6420
Mailing address
1201 N STONEWALL AVE, OKLAHOMA CITY, OK 73117-1214

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
7318
OK
1223P0700X
Prosthodontics
Primary
7318
OK
390200000X
Student in an Organized Health Care Education/Training Program
7318
OK

Other

Enumeration date
04/16/2020
Last updated
08/05/2025
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