Provider Demographics
NPI:1184013575
Name:KRISTIN N. MOORE, D.M.D., M.S., P.C.
Entity Type:Organization
Organization Name:KRISTIN N. MOORE, D.M.D., M.S., P.C.
Other - Org Name:MOORE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-401-3283
Mailing Address - Street 1:900 WEST ROUTE 22
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047
Mailing Address - Country:US
Mailing Address - Phone:847-438-9090
Mailing Address - Fax:
Practice Address - Street 1:900 WEST IL ROUTE 22
Practice Address - Street 2:SUITE 170
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047
Practice Address - Country:US
Practice Address - Phone:847-438-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021.0024741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1639503519OtherNPI