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General NPI Number Information
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NPI Number | 1447302054
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Entity Type | Organization
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Legal Business Name | DANIEL J MOORE DDS A PROFESSIONAL DENTAL CORP
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 02/06/2013
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Provider Practice Location Address
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Address Line | 1117 HOMER ROAD
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City | MINDEN
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State | LA
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Zip | 71058
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Country | US
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Telephone | 318-371-2211
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 310 1117 HOMER ROAD
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City | MINDEN
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State | LA
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Zip | 71058
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Country | US
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Telephone | 318-371-2211
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Fax |
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Authorized Official
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Title or Position | DOCTOR DENTIST
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Name | DR. DANIEL J MOORE
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Credential | DDS
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Telephone | 318-371-2211
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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 | 3860
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License Number State | LA
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