Provider Demographics
NPI:1427156181
Name:THOMAS L. MOFFETT, DDS, P.C.
Entity type:Organization
Organization Name:THOMAS L. MOFFETT, DDS, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOFFETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-561-1118
Mailing Address - Street 1:7983 PAXTON ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-5428
Mailing Address - Country:US
Mailing Address - Phone:717-561-1118
Mailing Address - Fax:717-564-9066
Practice Address - Street 1:7983 PAXTON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-5428
Practice Address - Country:US
Practice Address - Phone:717-561-1118
Practice Address - Fax:717-564-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018451L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA174605OtherUNITED CONCORDIA
PA1984262OtherUNITED CONCORDIA - PRACTICE
PA1983052OtherUNITED CONCORDIA WILLIAM L. MOFFETT, DMD