Provider Demographics
NPI:1063530814
Name:MICHAEL E. MOATS
Entity type:Organization
Organization Name:MICHAEL E. MOATS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOATS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-279-1440
Mailing Address - Street 1:135 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-8213
Mailing Address - Country:US
Mailing Address - Phone:847-279-1440
Mailing Address - Fax:847-279-1450
Practice Address - Street 1:135 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-8213
Practice Address - Country:US
Practice Address - Phone:847-279-1440
Practice Address - Fax:847-279-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty