MEDICARE: RICHARD W. MOORE DDS PC

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
1	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist	663456	OR

General Provider Information

NPI Number	:	1841435203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD W. MOORE DDS PC

Provider Business Mailing Address
First Line	:	7931 NE HALSEY ST
Second Line	:	SUITE 305
City	:	PORTLAND
State	:	OR
Zip	:	97213-6755
Country	:	US
Telephone Number	:	503-255-1200
Fax Number	:	503-408-6856

Provider Business Practice Location Address
First Line	:	7931 NE HALSEY ST
Second Line	:	SUITE 305
City	:	PORTLAND
State	:	OR
Zip	:	97213-6755
Country	:	US
Telephone Number	:	503-255-1200
Fax Number	:	503-408-6856

Authorized Official
Title or Position	:	OFFICE MANAGER/CFO
Name	:	NINA LE TRINH
Credential	:
Telephone Number	:	503-255-1200

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	02/03/2009

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