Provider Demographics
NPI:1063643831
Name:MOORE, JAMES DEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DEAN
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 1:178 BUCKHORN RD
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9735
Mailing Address - Country:US
Mailing Address - Phone:970-884-7191
Mailing Address - Fax:
Practice Address - Street 1:800 S CAMINO DEL RIO
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6898
Practice Address - Country:US
Practice Address - Phone:970-259-2264
Practice Address - Fax:970-259-7073
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO100041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice