Provider Demographics
NPI:1093133787
Name:MOORE, LINDSAY DEANNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:DEANNA
Last Name:MOORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12889 QUEBEC ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-9623
Mailing Address - Country:US
Mailing Address - Phone:720-726-6830
Mailing Address - Fax:
Practice Address - Street 1:12889 QUEBEC ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-9623
Practice Address - Country:US
Practice Address - Phone:720-726-6830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA65341223G0001X
390200000X
CODEN.002029691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program