Provider Demographics
NPI:1275176513
Name:MOORE, BRANDON LEE (DDS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:LEE
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:BRANDON
Other - Middle Name:LEE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR MOORE
Mailing Address - Street 1:9568 CASTLE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80129-5701
Mailing Address - Country:US
Mailing Address - Phone:720-436-7829
Mailing Address - Fax:
Practice Address - Street 1:2323 S WADSWORTH BLVD STE 1778
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-3274
Practice Address - Country:US
Practice Address - Phone:303-355-8670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00204194122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist