Provider Demographics
NPI:1306245329
Name:MOANA FILHO, ESTEPHAN J (DDS, MS, PHD)
Entity type:Individual
Prefix:DR
First Name:ESTEPHAN
Middle Name:J
Last Name:MOANA FILHO
Suffix:
Gender:M
Credentials:DDS, MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 DELAWARE ST SE
Mailing Address - Street 2:6-320D MOOS TOWER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0357
Mailing Address - Country:US
Mailing Address - Phone:612-624-3130
Mailing Address - Fax:612-626-0138
Practice Address - Street 1:515 DELAWARE ST SE
Practice Address - Street 2:6-440 MOOS TOWER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0357
Practice Address - Country:US
Practice Address - Phone:612-626-0140
Practice Address - Fax:612-626-0138
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNFF64122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist