Provider Demographics
NPI:1003901661
Name:JEFFREY W MOORE DDS PA
Entity Type:Organization
Organization Name:JEFFREY W MOORE DDS PA
Other - Org Name:NORTH STAR DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-238-5665
Mailing Address - Street 1:4011 E. RENNER ROAD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2917
Mailing Address - Country:US
Mailing Address - Phone:972-238-5665
Mailing Address - Fax:972-238-5765
Practice Address - Street 1:4011 E. RENNER ROAD
Practice Address - Street 2:SUITE #107
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2917
Practice Address - Country:US
Practice Address - Phone:972-238-5665
Practice Address - Fax:972-238-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty