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General NPI Number Information
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NPI Number | 1669734513
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Entity Type | Individual
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Provider Name | MILES CLINTON MOORE DDS
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Gender | Male
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 725 W BROOKHAVEN CIR
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City | MEMPHIS
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State | TN
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Zip | 38117-4503
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Country | US
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Telephone | 901-761-2210
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Fax | 901-763-1092
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Provider Business Mailing Address
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Address Line | 725 W. BROOKHAVEN CR.
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City | MEMPHIS
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State | TN
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Zip | 38117
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Country | UM
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Telephone | 901-761-2210
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Fax | 901-763-1092
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 9489
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License Number State | TN
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