Provider Demographics
NPI:1356821763
Name:FENCH H. MOORE, III .D.D.S, PC
Entity Type:Organization
Organization Name:FENCH H. MOORE, III .D.D.S, PC
Other - Org Name:ABINGDON SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRENCH
Authorized Official - Middle Name:HALE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:276-628-7862
Mailing Address - Street 1:321 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2921
Mailing Address - Country:US
Mailing Address - Phone:276-628-7862
Mailing Address - Fax:276-628-7902
Practice Address - Street 1:321 COURT STREET
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2921
Practice Address - Country:US
Practice Address - Phone:276-628-7862
Practice Address - Fax:276-628-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010065021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty