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General NPI Number Information
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NPI Number | 1972012748
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Entity Type | Organization
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Legal Business Name | PEARL CDA-MOORE, DDS, LLC
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 09/25/2017
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Provider Practice Location Address
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Address Line | 112 JEFFERSON AVE STE 2
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City | COLUMBUS
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State | OH
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Zip | 43215-1861
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Country | US
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Telephone | 614-914-8338
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Fax | 614-917-8392
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Provider Business Mailing Address
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Address Line | 112 JEFFERSON AVE STE 2
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City | COLUMBUS
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State | OH
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Zip | 43215-1861
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Country | US
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Telephone | 614-914-8338
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Fax | 614-914-8392
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Authorized Official
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Title or Position | DENTIST/MANAGING MEMBER
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Name | DR. WHITNEY MONET MOORE
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Credential | DDS
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Telephone | 614-914-8338
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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 |
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License Number State |
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