Provider Demographics
NPI:1164597811
Name:POORE, FRANK JEFFERSON JR (DMD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:JEFFERSON
Last Name:POORE
Suffix:JR
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-0669
Mailing Address - Country:US
Mailing Address - Phone:704-663-1354
Mailing Address - Fax:704-662-3213
Practice Address - Street 1:672 CARPENTER AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2538
Practice Address - Country:US
Practice Address - Phone:704-633-1354
Practice Address - Fax:704-662-3213
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
058688359OtherADA