Healthcare Provider Details

I. General information

NPI: 1669511374
Provider Name (Legal Business Name): ROBERT DANNY MOORE DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 PENN PLZ
BANGOR ME
04401-3620
US

IV. Provider business mailing address

24 PENN PLZ
BANGOR ME
04401-3620
US

V. Phone/Fax

Practice location:
  • Phone: 207-848-2806
  • Fax: 207-947-5237
Mailing address:
  • Phone: 207-848-2806
  • Fax: 207-947-5237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number3658
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: