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General NPI Number Information
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NPI Number | 1790812816
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Entity Type | Individual
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Provider Name | DEAN L MOORE DPM
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 16633 DALLAS PKWY SUITE 600
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City | ADDISON
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State | TX
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Zip | 75001-6816
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Country | US
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Telephone | 619-633-8584
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Fax | 760-231-9135
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Provider Business Mailing Address
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Address Line | 1021 COSTA PACIFICA WAY UNIT 2213
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City | OCEANSIDE
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State | CA
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Zip | 92054-2195
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Country | US
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Telephone | 619-633-8584
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Fax | 760-231-9135
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 1700
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License Number State | TX
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