Healthcare Provider Details

I. General information

NPI: 1821008178
Provider Name (Legal Business Name): DRS. BARTS & MOORE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 E 4TH ST SUITE 804
CHARLOTTE NC
28204-3261
US

IV. Provider business mailing address

1718 E 4TH ST SUITE 804
CHARLOTTE NC
28204-3261
US

V. Phone/Fax

Practice location:
  • Phone: 704-358-8898
  • Fax: 704-358-8889
Mailing address:
  • Phone: 704-358-8898
  • Fax: 704-358-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5366
License Number StateNC

VIII. Authorized Official

Name: DR. KENT E MOORE
Title or Position: ORAL & MAXILLOFACIAL SURGEON
Credential: DDS, MD
Phone: 704-358-8898