Provider Demographics
NPI:1194728006
Name:MOFFATT, TOBY BRYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:TOBY
Middle Name:BRYAN
Last Name:MOFFATT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TOBY
Other - Middle Name:BRYAN
Other - Last Name:MOFFATT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1510 W CAUSEWAY APPROACH
Mailing Address - Street 2:STE A
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3022
Mailing Address - Country:US
Mailing Address - Phone:985-757-4848
Mailing Address - Fax:985-727-4899
Practice Address - Street 1:1510 W CAUSEWAY APPROACH
Practice Address - Street 2:STE A
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3022
Practice Address - Country:US
Practice Address - Phone:985-757-4848
Practice Address - Fax:985-727-4899
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice