| Michael W. Moffitt Dds | |
|
422 W Broadway St Eagle Grove IA 50533-1704 | |
| (515) 448-4852 | |
| (515) 448-3533 |
| Full Name | Michael W. Moffitt Dds |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 422 W Broadway St, Eagle Grove, Iowa |
| Authorized Official Name and Position | Michael Walter Moffitt (OWNER/DOCTOR) |
| Authorized Official Contact | 5154484852 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael W. Moffitt Dds 422 W Broadway St Eagle Grove IA 50533-1704 Ph: (515) 448-4852 | Michael W. Moffitt Dds 422 W Broadway St Eagle Grove IA 50533-1704 Ph: (515) 448-4852 |
| NPI Number | 1205093903 |
|---|---|
| Provider Enumeration Date | 05/20/2008 |
| Last Update Date | 05/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205093903 | NPI | - | NPPES |
| 0148007 | Medicaid | IA | |
| 010720525 | Other | IA | AMERICAN DENTAL ASSOCIATION |
| 1613 | Other | IA | AMERICAN COLLEGE OF PROSTHODONTICS |
| 14800 | Other | IA | WELLMARK BLUE CROSS/BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 6102 (Iowa) | Primary |
Eagle Grove Family Dentistry Plc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 306 W Broadway St, Eagle Grove, IA 50533 Phone: 515-448-5022 Fax: 515-448-5537 |