Provider Demographics
NPI:1043273287
Name:MOORE, LEONARD RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:RAY
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 1:1426 STAMPEDE AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4226
Mailing Address - Country:US
Mailing Address - Phone:307-587-6028
Mailing Address - Fax:307-587-6506
Practice Address - Street 1:1426 STAMPEDE AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4226
Practice Address - Country:US
Practice Address - Phone:307-587-6028
Practice Address - Fax:307-587-6506
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice