Provider Demographics
NPI:1306812284
Name:MOYA, LEONARDO II (DDS)
Entity type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:MOYA
Suffix:II
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 1:3630 SE MILITARY DR
Mailing Address - Street 2:114
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223
Mailing Address - Country:US
Mailing Address - Phone:210-337-6834
Mailing Address - Fax:210-337-6551
Practice Address - Street 1:3630 SE MILITARY DR
Practice Address - Street 2:114
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78223
Practice Address - Country:US
Practice Address - Phone:210-337-6834
Practice Address - Fax:210-337-6551
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20527122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188970101Medicaid