Individual
JORDAN MICHAEL MOFFITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
422 WEST BROADWAY, EAGLE GROVE, IA 50533-1704
(515) 448-4852
(515) 448-3533
Mailing address
422 WEST BROADWAY, EAGLE GROVE, IA 50533-1704
(515) 448-4852
(515) 448-3533
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
9223
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
271500633
—
IA
Enumeration date
07/01/2015
Last updated
07/01/2015
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