MEDICARE: DR. CHARLES WILLIAM MOORE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN15214	FL

General Provider Information

NPI Number	:	1578624276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES WILLIAM MOORE DMD

Provider Business Mailing Address
First Line	:	6025 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615
Country	:	US
Telephone Number	:	813-886-2527
Fax Number	:	813-887-3225

Provider Business Practice Location Address
First Line	:	6025 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615
Country	:	US
Telephone Number	:	813-886-2527
Fax Number	:	813-887-3225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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