Provider Demographics
NPI:1063553907
Name:MOFFITT, ROBERT E (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:MOFFITT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 PARK RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1022
Mailing Address - Country:US
Mailing Address - Phone:202-387-6043
Mailing Address - Fax:703-339-1068
Practice Address - Street 1:7764 ARMISTEAD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1919
Practice Address - Country:US
Practice Address - Phone:703-339-5090
Practice Address - Fax:703-339-1068
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010059971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA781417OtherUNITED CONCORDIA PROVIDER