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General NPI Number Information
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NPI Number | 1376657825
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Entity Type | Individual
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Provider Name | TRACYE A. MOORE RDH, BS, MS
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | NAVAL HEALTH CLINIC JOINT RESERVE BASE DENTAL DEPARTMENT BLDG 137
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City | WILLOW GROVE
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State | PA
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Zip | 19090
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Country | US
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Telephone | 215-443-6380
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Fax | 215-443-6378
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Provider Business Mailing Address
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Address Line | 324 E PHIL ELLENA ST
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1941
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Country | US
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Telephone | 215-438-6199
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Fax | 215-443-6378
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH008983L
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License Number State | PA
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