Provider Demographics
NPI:1407971039
Name:MOORE, CECIL BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:BRIAN
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 1:363 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-2505
Mailing Address - Country:US
Mailing Address - Phone:828-287-4187
Mailing Address - Fax:828-286-8649
Practice Address - Street 1:363 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTHERFORDTON
Practice Address - State:NC
Practice Address - Zip Code:28139-2505
Practice Address - Country:US
Practice Address - Phone:828-287-4187
Practice Address - Fax:828-286-8649
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6705690001Medicare PIN