NPIMap

Organization Active NPI

Moffitt Dental Center

  • Dental Clinic/Center
  • Eagle Grove, IA
National Provider Identifier
1205093903
Registry record updated May 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
6102 Issued in IA
Legal business name
MOFFITT DENTAL CENTER
Practice address
422 W Broadway St
Eagle Grove, IA 50533-1704
Phone
(515) 448-4852
Fax
(515) 448-3533
NPI assigned
May 20, 2008
Last updated
May 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael Walter Moffitt, DDSNPI 1225052343
Title
Owner/Doctor
Phone
(515) 448-4852

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 6102 IA Primary

Addresses

Primary practice location

422 W Broadway St
Eagle Grove, IA 50533-1704

Mailing address

422 W Broadway St
Eagle Grove, IA 50533-1704
Phone (515) 448-4852

Other identifiers 4

IdentifierTypeStateIssuer
0148007MedicaidIA
010720525OtherIAAMERICAN DENTAL ASSOCIATION
1613OtherIAAMERICAN COLLEGE OF PROSTHODONTICS
14800OtherIAWELLMARK BLUE CROSS/BLUE SHIELD

Other names 1

  • Michael W. Moffitt DDS Other name

National Provider Directory

National Provider Directory

Locations

422 W Broadway St
Eagle Grove, IA 50533
Phone (515) 448-4852

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1205093903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 W BROADWAY ST",
            "city": "EAGLE GROVE",
            "state": "IA",
            "postal_code": "505331704",
            "telephone_number": "515-448-4852",
            "fax_number": "515-448-3533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "422 W BROADWAY ST",
            "city": "EAGLE GROVE",
            "state": "IA",
            "postal_code": "505331704",
            "telephone_number": "515-448-4852",
            "fax_number": "515-448-3533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOFFITT DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "MOFFITT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "515-448-4852",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IA",
            "license": "6102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0148007",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN DENTAL ASSOCIATION",
            "identifier": "010720525",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN COLLEGE OF PROSTHODONTICS",
            "identifier": "1613",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CROSS/BLUE SHIELD",
            "identifier": "14800",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Michael W. Moffitt DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Eagle Grove, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.