Healthcare Provider Details

I. General information

NPI: 1437739448
Provider Name (Legal Business Name): CANDACE N MOORE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 W ARBROOK BLVD STE 6
ARLINGTON TX
76015-4211
US

IV. Provider business mailing address

2820 TRINITY OAKS DR APT 155
ARLINGTON TX
76006-2237
US

V. Phone/Fax

Practice location:
  • Phone: 817-900-6116
  • Fax:
Mailing address:
  • Phone: 817-500-3522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number13783
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: