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General NPI Number Information
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NPI Number | 1205968120
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Entity Type | Organization
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Legal Business Name | MOORE DENTAL SERVICES, INC
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 01/19/2021
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Provider Practice Location Address
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Address Line | 59 CAVALIER BLVD 300
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City | FLORENCE
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State | KY
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Zip | 41042
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Country | US
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Telephone | 859-525-0507
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Fax | 859-525-0610
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Provider Business Mailing Address
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Address Line | 59 CAVALIER BLVD 300
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City | FLORENCE
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State | KY
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Zip | 41042
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Country | US
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Telephone | 859-525-0507
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Fax | 859-525-0610
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Authorized Official
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Title or Position | PRES
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Name | MARTIN JOSEPH MOORE
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Credential |
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Telephone | 859-371-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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