Provider Demographics
NPI:1336289040
Name:MOORE, S. JEFF (DDS)
Entity Type:Individual
Prefix:DR
First Name:S. JEFF
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:SAMUEL
Other - Middle Name:JEFFERSON
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:8935 GOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-2201
Mailing Address - Country:US
Mailing Address - Phone:662-895-5012
Mailing Address - Fax:662-895-4616
Practice Address - Street 1:8935 GOODMAN RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-2201
Practice Address - Country:US
Practice Address - Phone:662-895-5012
Practice Address - Fax:662-895-4616
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007162-C1223G0001X
MS2742931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice