Healthcare Provider Details

I. General information

NPI: 1841435203
Provider Name (Legal Business Name): RICHARD W. MOORE DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7931 NE HALSEY ST SUITE 305
PORTLAND OR
97213-6755
US

IV. Provider business mailing address

7931 NE HALSEY ST SUITE 305
PORTLAND OR
97213-6755
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-1200
  • Fax: 503-408-6856
Mailing address:
  • Phone: 503-255-1200
  • Fax: 503-408-6856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number663456
License Number StateOR

VIII. Authorized Official

Name: NINA LE TRINH
Title or Position: OFFICE MANAGER/CFO
Credential:
Phone: 503-255-1200