Provider Demographics
NPI:1114289394
Name:MOORE, ALECIA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALECIA
Middle Name:A
Last Name:MOORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4160
Mailing Address - Country:US
Mailing Address - Phone:601-267-3722
Mailing Address - Fax:601-267-0338
Practice Address - Street 1:97 HAL CROCKER RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MS
Practice Address - Zip Code:39437-2088
Practice Address - Country:US
Practice Address - Phone:601-477-3779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3638-121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice