Provider Demographics
NPI:1326242348
Name:MOORE, KATHRYN ANN (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ANN
Last Name:MOORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:K
Other - Middle Name:ANN
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:700 SUNRISE AVE
Mailing Address - Street 2:#C
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661
Mailing Address - Country:US
Mailing Address - Phone:916-782-1209
Mailing Address - Fax:916-782-1770
Practice Address - Street 1:700 SUNRISE AVE
Practice Address - Street 2:#C
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661
Practice Address - Country:US
Practice Address - Phone:916-782-1209
Practice Address - Fax:916-782-1770
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry