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General NPI Number Information
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NPI Number | 1356821763
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Entity Type | Organization
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Legal Business Name | FENCH H. MOORE, III .D.D.S, PC
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 321 COURT STREET
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City | ABINGDON
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State | VA
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Zip | 24210-2921
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Country | US
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Telephone | 276-628-7862
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Fax | 276-628-7902
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Provider Business Mailing Address
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Address Line | 321 COURT STREET
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City | ABINGDON
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State | VA
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Zip | 24210-2921
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Country | US
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Telephone | 276-628-7862
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Fax | 276-628-7902
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Authorized Official
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Title or Position | OWNER
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Name | FRENCH HALE MOORE III
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Credential | D.D.S. PC
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Telephone | 276-628-7862
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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 | 0401006502
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License Number State | VA
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