Provider Demographics
NPI:1255507224
Name:TIMOTHY E. MOORE, DDS, MS, PC
Entity Type:Organization
Organization Name:TIMOTHY E. MOORE, DDS, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-494-7676
Mailing Address - Street 1:7134 S YALE AVE
Mailing Address - Street 2:SUITE #400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-6372
Mailing Address - Country:US
Mailing Address - Phone:918-494-7676
Mailing Address - Fax:918-494-0806
Practice Address - Street 1:7134 S YALE AVE
Practice Address - Street 2:SUITE #400
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-6372
Practice Address - Country:US
Practice Address - Phone:918-494-7676
Practice Address - Fax:918-494-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK39811223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty