Provider Demographics
NPI:1174683676
Name:MOORE, JONAH R (DDS)
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:R
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2413
Mailing Address - Country:US
Mailing Address - Phone:504-899-2333
Mailing Address - Fax:504-897-6531
Practice Address - Street 1:3430 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2413
Practice Address - Country:US
Practice Address - Phone:504-899-2333
Practice Address - Fax:504-897-6531
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA51971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice