Healthcare Provider Details

I. General information

NPI: 1508703018
Provider Name (Legal Business Name): MOORE FAMILY DENTAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E SHILOH RD
CORINTH MS
38834-2620
US

IV. Provider business mailing address

900 E SHILOH RD
CORINTH MS
38834-2620
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-1171
  • Fax: 662-287-2575
Mailing address:
  • Phone: 662-287-1171
  • Fax: 662-287-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ANDREW FANCHER MOORE
Title or Position: DENTIST/OWNER
Credential: DMD
Phone: 662-287-1171