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General NPI Number Information
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NPI Number | 1164564951
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Entity Type | Individual
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Provider Name | ARTHUR WILLIAM MOORE III D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2024 EDGEWOOD DR S
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City | LAKELAND
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State | FL
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Zip | 33803-3637
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Country | US
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Telephone | 863-667-4726
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Fax | 863-665-8399
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Provider Business Mailing Address
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Address Line | 6702 HAYTER DR
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City | LAKELAND
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State | FL
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Zip | 33813-3535
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Country | US
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Telephone | 863-646-1559
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN14629
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License Number State | FL
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