Healthcare Provider Details

I. General information

NPI: 1003578816
Provider Name (Legal Business Name): MEGAN ELIZABETH MOORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN ELIZABETH MOORE RDH

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 BARB ST STE A
SILVERDALE WA
98315-2050
US

IV. Provider business mailing address

5188 SINCLAIR WAY
BREMERTON WA
98312-4679
US

V. Phone/Fax

Practice location:
  • Phone: 360-315-4391
  • Fax:
Mailing address:
  • Phone: 850-445-6257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH043449
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: