Provider Demographics
NPI:1104179597
Name:MOORE, SHERI ANN (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:SHERI
Other - Middle Name:ANN
Other - Last Name:HENRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:82 BIRCH WAY
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22923-2728
Mailing Address - Country:US
Mailing Address - Phone:434-218-3793
Mailing Address - Fax:434-218-3793
Practice Address - Street 1:1461 GREENBRIER PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1697
Practice Address - Country:US
Practice Address - Phone:434-977-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402004089124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist