Provider Demographics
NPI:1437126646
Name:NILES-MOORE, NORMA DALE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:DALE
Last Name:NILES-MOORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:DALE
Other - Last Name:NILES-MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2759 NORTH TYLER ROAD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-721-4334
Mailing Address - Fax:
Practice Address - Street 1:2759 NORTH TYLER ROAD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-721-4334
Practice Address - Fax:316-773-4592
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6069122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist