Provider Demographics
NPI:1891257796
Name:MOYNIHAN, ANNA (DMD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MOYNIHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:PIETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1807 S WASHINGTON ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565
Mailing Address - Country:US
Mailing Address - Phone:630-369-3120
Mailing Address - Fax:
Practice Address - Street 1:1807 S WASHINGTON ST
Practice Address - Street 2:SUITE 107
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565
Practice Address - Country:US
Practice Address - Phone:630-369-3120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL-1223G0001X
IL019.0325371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice