Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN11639 | FL |
NPI | 1043238165 |
---|---|
Provider Name | Dr. Margherita Graziosa De Moya |
First Address | Fort Walton Beach, FL 32548-4502 |
Second Address | Fort Walton Beach, FL 32548-4502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 13/12/2010 |