Provider Demographics
NPI:1295627388
Name:MOAK, AUBURN ANSLEY (DMD)
Entity type:Individual
Prefix:
First Name:AUBURN
Middle Name:ANSLEY
Last Name:MOAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 COUNTY ROAD 8
Mailing Address - Street 2:
Mailing Address - City:STRINGER
Mailing Address - State:MS
Mailing Address - Zip Code:39481-4330
Mailing Address - Country:US
Mailing Address - Phone:601-577-6686
Mailing Address - Fax:
Practice Address - Street 1:806 MISSISSIPPI DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2438
Practice Address - Country:US
Practice Address - Phone:601-735-5086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1113211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice