Individual provider Active NPI

David J Moyer, DDS,MD

  • Oral and Maxillofacial Surgery (Dentist)
  • South Portland, ME
National Provider Identifier
1881684587
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
12684 Issued in ME
Practice address
20 Long Creek Dr
Suite B
South Portland, ME 04106-2425
Phone
(207) 772-4063
Fax
(207) 772-8641
NPI assigned
Oct 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 12684 ME Primary

Addresses

Primary practice location

20 Long Creek Dr
Suite B
South Portland, ME 04106-2425

Mailing address

20 Long Creek Dr
Suite B
South Portland, ME 04106-2425
Phone (207) 772-4063

Other identifiers 1

IdentifierTypeStateIssuer
3074500099MedicaidME

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.
Opted out of Medicare
Yes, effective Sep 1, 2013 through Sep 1, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
12684MEMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Oral & Maxillofacial Surgery Associates PA Oral and Maxillofacial Surgery Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881684587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 LONG CREEK DR",
            "address_2": "SUITE B",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041062425",
            "telephone_number": "207-772-4063",
            "fax_number": "207-772-8641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 LONG CREEK DR",
            "address_2": "SUITE B",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041062425",
            "telephone_number": "207-772-4063",
            "fax_number": "207-772-8641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOYER",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "DDS,MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ME",
            "license": "12684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3074500099",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Portland, ME

Sources for this page

Verify at the official NPI Registry.