Provider Demographics
NPI:1033228887
Name:MOORE, NATHAN SETH (DDS)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:SETH
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2313 SANTA CLARA J1
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:UT
Mailing Address - Zip Code:84765-5472
Mailing Address - Country:US
Mailing Address - Phone:435-652-4100
Mailing Address - Fax:435-673-3978
Practice Address - Street 1:2313 SANTA CLARA J1
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:UT
Practice Address - Zip Code:84765-5472
Practice Address - Country:US
Practice Address - Phone:435-652-4100
Practice Address - Fax:435-673-3978
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT510801699221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice