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NPI Code Detail

MEDICARE: DR. HENRY DUNBAR MOORE D.D.S.

MEDICARE: DR. HENRY DUNBAR 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
11223G0001XGeneral Practice Dentistry1918737IL

General Provider Information

NPI Number : 1942367859
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HENRY DUNBAR MOORE D.D.S.
Provider Business Mailing Address
First Line : 1111 E. 87TH STREET
Second Line :
City : CHICAGO
State : IL
Zip : 60619
Country : US
Telephone Number : 773-374-9778
Fax Number : 773-374-9013
Provider Business Practice Location Address
First Line : 1111 E 87TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60619-7038
Country : US
Telephone Number : 773-374-9778
Fax Number : 773-374-9013
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/02/2007
Last Update Date : 08/20/2007

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