Provider Demographics
NPI:1073715843
Name:FAMILY DENTISTRY ALICE H MOORE DDS AND LORNA L PETERSEN DMD PC
Entity Type:Organization
Organization Name:FAMILY DENTISTRY ALICE H MOORE DDS AND LORNA L PETERSEN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:215-257-5095
Mailing Address - Street 1:1316 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944
Mailing Address - Country:US
Mailing Address - Phone:215-257-5095
Mailing Address - Fax:215-257-3941
Practice Address - Street 1:1316 N 5TH ST
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944
Practice Address - Country:US
Practice Address - Phone:215-257-5095
Practice Address - Fax:215-257-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty