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General NPI Number Information
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NPI Number | 1235427972
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Entity Type | Individual
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Provider Name | LACHELLE HENDLEY MOORE DMD
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Gender | Female
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Dates
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Enumeration Date | 07/15/2011
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 209 LATITUDE LANE
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City | CLOVER
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State | SC
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Zip | 29710
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Country | US
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Telephone | 803-619-4511
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Fax | 803-619-4586
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Provider Business Mailing Address
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Address Line | 209 LATITUDE LANE
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City | CLOVER
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State | SC
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Zip | 29710
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Country | US
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Telephone | 803-619-4511
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Fax | 803-619-4586
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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 | DN19455
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8665
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License Number State | SC
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