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General NPI Number Information
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NPI Number | 1922169275
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Entity Type | Organization
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Legal Business Name | DOUGLAS W MOORE DDS PC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 1011 A AVE W
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City | OSKALOOSA
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State | IA
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Zip | 52577
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Country | US
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Telephone | 641-673-9411
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Fax | 641-673-8109
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Provider Business Mailing Address
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Address Line | 1011 A AVE W
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City | OSKALOOSA
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State | IA
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Zip | 52577
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Country | US
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Telephone | 641-673-9411
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Fax | 641-673-8109
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. DOUGLAS W MOORE
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Credential | DDS
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Telephone | 641-673-9411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 07236
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License Number State | IA
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