Provider Demographics
NPI:1437599461
Name:THOMAS, KYRSLYNE MOORE (DMD)
Entity Type:Individual
Prefix:
First Name:KYRSLYNE
Middle Name:MOORE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23678 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3336
Mailing Address - Country:US
Mailing Address - Phone:251-928-8770
Mailing Address - Fax:
Practice Address - Street 1:23678 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-3336
Practice Address - Country:US
Practice Address - Phone:251-928-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL62331223G0001X
GADN0146021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice