Provider Demographics
NPI:1275687576
Name:MOORE, ABNER G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ABNER
Middle Name:G
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 JONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1103
Mailing Address - Country:US
Mailing Address - Phone:770-961-6131
Mailing Address - Fax:770-961-7555
Practice Address - Street 1:5918 JONESBORO RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1103
Practice Address - Country:US
Practice Address - Phone:770-961-6131
Practice Address - Fax:770-961-7555
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice