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General NPI Number Information
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NPI Number | 1689972663
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Entity Type | Organization
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Legal Business Name | RANDALL A. MOORE, DMD,PC
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Dates
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Enumeration Date | 03/01/2011
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Last Update Date | 03/01/2011
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Provider Practice Location Address
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Address Line | 351 MANVILLE RD
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-2152
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Country | US
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Telephone | 914-769-2626
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Fax |
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Provider Business Mailing Address
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Address Line | 351 MANVILLE RD
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City | PLEASANTVILLE
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State | NY
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Zip | 10570-2152
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Country | US
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Telephone | 914-769-2626
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDALL A. MOORE
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Credential | DMD
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Telephone | 914-769-2626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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