Provider Demographics
NPI:1902913031
Name:MOY, RAYMOND M (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:M
Last Name:MOY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:YOK
Other - Middle Name:M
Other - Last Name:MOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:914 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BARSTOW
Mailing Address - State:CA
Mailing Address - Zip Code:92311-2406
Mailing Address - Country:US
Mailing Address - Phone:760-256-9373
Mailing Address - Fax:760-256-1263
Practice Address - Street 1:914 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARSTOW
Practice Address - State:CA
Practice Address - Zip Code:92311-2406
Practice Address - Country:US
Practice Address - Phone:760-256-9373
Practice Address - Fax:760-256-1263
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice