Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 6102 | IA |
NPI | 1225052343 |
---|---|
Provider Name | Dr. Michael W Moffitt |
First Address | Eagle Grove, IA 50533-1704 |
Second Address | Eagle Grove, IA 50533-1704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |