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General NPI Number Information
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NPI Number | 1619168861
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Entity Type | Organization
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Legal Business Name | JAMES T MOORE, DDS, PC
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 11520 SAINT CHARLES ROCK RD SUTIE 205
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City | BRIDGETON
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State | MO
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Zip | 63044-2732
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Country | US
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Telephone | 314-298-7772
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Fax | 314-298-9895
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Provider Business Mailing Address
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Address Line | 11520 SAINT CHARLES ROCK RD SUTIE 205
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City | BRIDGETON
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State | MO
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Zip | 63044-2732
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Country | US
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Telephone | 314-298-7772
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Fax | 314-298-9895
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES T MOORE
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Credential | DDS
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Telephone | 314-298-7772
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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 | 11925
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License Number State | MO
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