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General NPI Number Information
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NPI Number | 1942185434
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Entity Type | Individual
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Provider Name | NICHOLAS A MOORE DMD
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Gender | Male
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 8950 MAIN ST
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City | WOODSTOCK
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State | GA
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Zip | 30188-4908
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Country | US
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Telephone | 770-926-4447
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 POWERS FRD SE
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City | MARIETTA
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State | GA
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Zip | 30067-5189
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Country | US
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Telephone | 770-356-7119
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Fax |
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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 | DN123913
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License Number State | GA
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