Provider Demographics
NPI:1407348782
Name:MOORE, JAMES CHESNUT III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHESNUT
Last Name:MOORE
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4160
Mailing Address - Country:US
Mailing Address - Phone:601-267-3722
Mailing Address - Fax:
Practice Address - Street 1:107 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4160
Practice Address - Country:US
Practice Address - Phone:601-267-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3999-18122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist