Provider Demographics
NPI:1538249040
Name:MOYANA, REUBEN TAFADZWA (DMD)
Entity type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:TAFADZWA
Last Name:MOYANA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 LEE ROAD 2200
Mailing Address - Street 2:
Mailing Address - City:SMITHS STATION
Mailing Address - State:AL
Mailing Address - Zip Code:36877-3388
Mailing Address - Country:US
Mailing Address - Phone:205-991-7398
Mailing Address - Fax:334-298-2725
Practice Address - Street 1:2409 SPORTSMAN DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-5402
Practice Address - Country:US
Practice Address - Phone:334-297-5890
Practice Address - Fax:334-298-2725
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL53441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice