Provider Demographics
NPI:1235392929
Name:MOORE, JULIE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4351 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGHILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606
Mailing Address - Country:US
Mailing Address - Phone:352-597-4977
Mailing Address - Fax:352-597-9263
Practice Address - Street 1:4351 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRINGHILL
Practice Address - State:FL
Practice Address - Zip Code:34606
Practice Address - Country:US
Practice Address - Phone:352-597-4977
Practice Address - Fax:352-597-9263
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17935122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist