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General NPI Number Information
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NPI Number | 1114289394
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Entity Type | Individual
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Provider Name | ALECIA A MOORE DMD
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Gender | Female
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 07/03/2015
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Provider Practice Location Address
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Address Line | 97 HAL CROCKER RD
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City | ELLISVILLE
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State | MS
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Zip | 39437-2088
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Country | US
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Telephone | 601-477-3779
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Fax |
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Provider Business Mailing Address
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Address Line | 107 N VAN BUREN ST
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City | CARTHAGE
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State | MS
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Zip | 39051-4160
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Country | US
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Telephone | 601-267-3722
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Fax | 601-267-0338
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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 | 3638-12
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License Number State | MS
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