Provider Demographics
NPI:1588745228
Name:MOFFETT, JEFFREY VICTOR (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:VICTOR
Last Name:MOFFETT
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 1:275 BAYSHORE BLVD
Mailing Address - Street 2:805
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2328
Mailing Address - Country:US
Mailing Address - Phone:305-725-2315
Mailing Address - Fax:
Practice Address - Street 1:275 BAYSHORE BLVD
Practice Address - Street 2:805
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2328
Practice Address - Country:US
Practice Address - Phone:305-725-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN154501223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery