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General NPI Number Information
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NPI Number | 1013154673
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Entity Type | Individual
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Provider Name | ALFRED P MOORE DENTIST
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Gender | Male
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Dates
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Enumeration Date | 01/19/2009
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Last Update Date | 01/19/2009
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Provider Practice Location Address
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Address Line | 235 WYTHE CREEK RD
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City | POQUOSON
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State | VA
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Zip | 23662-1911
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Country | US
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Telephone | 757-868-8152
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Fax | 757-868-4507
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Provider Business Mailing Address
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Address Line | 235 WYTHE CREEK RD
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City | POQUOSON
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State | VA
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Zip | 23662-1911
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Country | US
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Telephone | 757-868-8152
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Fax | 757-868-4507
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401004269
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License Number State | VA
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