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General NPI Number Information
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NPI Number | 1518116896
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Entity Type | Organization
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Legal Business Name | MOORE FAMILY DENTISTRY
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Dates
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Enumeration Date | 09/11/2008
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Last Update Date | 09/11/2008
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Provider Practice Location Address
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Address Line | 257 COMMERCE DR
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1484
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Country | US
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Telephone | 770-487-8896
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Fax | 770-487-7887
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Provider Business Mailing Address
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Address Line | 257 COMMERCE DR
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-1484
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Country | US
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Telephone | 770-487-8896
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Fax | 770-487-7887
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Authorized Official
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Title or Position | OWNER
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Name | DR. CAROLYN MOORE
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Credential | DDS
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Telephone | 770-487-8896
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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 | DN012708
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License Number State | GA
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