Provider Demographics
NPI:1164564951
Name:MOORE, ARTHUR WILLIAM III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:WILLIAM
Last Name:MOORE
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6702 HAYTER DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3535
Mailing Address - Country:US
Mailing Address - Phone:863-646-1559
Mailing Address - Fax:
Practice Address - Street 1:2024 EDGEWOOD DR S
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3637
Practice Address - Country:US
Practice Address - Phone:863-667-4726
Practice Address - Fax:863-665-8399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14629122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist