Provider Demographics
NPI:1275642357
Name:MOORE, SANDY MEADE III (DDS, MS)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:MEADE
Last Name:MOORE
Suffix:III
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 EXETER RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2971
Mailing Address - Country:US
Mailing Address - Phone:901-683-3993
Mailing Address - Fax:901-683-8283
Practice Address - Street 1:1908 EXETER
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-2971
Practice Address - Country:US
Practice Address - Phone:901-683-3993
Practice Address - Fax:901-683-8283
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNDS 35611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry