Provider Demographics
NPI:1326249830
Name:MOORE, SCOTT E (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
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 1:4896 S 1900 W
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2994
Mailing Address - Country:US
Mailing Address - Phone:801-773-9198
Mailing Address - Fax:801-773-4424
Practice Address - Street 1:4896 S 1900 W
Practice Address - Street 2:SUITE B
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-2994
Practice Address - Country:US
Practice Address - Phone:801-773-9198
Practice Address - Fax:801-773-4424
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142282-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist