Healthcare Provider Details

I. General information

NPI: 1164564951
Provider Name (Legal Business Name): ARTHUR WILLIAM MOORE III D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 EDGEWOOD DR S
LAKELAND FL
33803-3637
US

IV. Provider business mailing address

6702 HAYTER DR
LAKELAND FL
33813-3535
US

V. Phone/Fax

Practice location:
  • Phone: 863-667-4726
  • Fax: 863-665-8399
Mailing address:
  • Phone: 863-646-1559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN14629
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: