Provider Demographics
NPI:1962415240
Name:MOY, PHILLIP (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:MOY
Suffix:
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 1:536 W BOUGHTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-5705
Mailing Address - Country:US
Mailing Address - Phone:630-759-1221
Mailing Address - Fax:630-759-3711
Practice Address - Street 1:536 W BOUGHTON RD
Practice Address - Street 2:SUITE A
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-5705
Practice Address - Country:US
Practice Address - Phone:630-759-1221
Practice Address - Fax:630-759-3711
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice