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NPI Code Detail

MEDICARE: DR. BRIAN DUANE MOORE D.D.S.

MEDICARE: DR. BRIAN DUANE MOORE D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryDS026705LPA

General Provider Information

NPI Number : 1548473226
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN DUANE MOORE D.D.S.
Provider Business Mailing Address
First Line : PO BOX 27539
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19118-0539
Country : US
Telephone Number : 215-242-5797
Fax Number : 215-242-1171
Provider Business Practice Location Address
First Line : 7156 STENTON AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19150-3428
Country : US
Telephone Number : 215-242-5797
Fax Number : 215-242-1171
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2007
Last Update Date : 07/08/2007

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