Provider Demographics
NPI:1457645046
Name:MOORE, DANIEL GREGG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:GREGG
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 1:127 ROYAL TROON LANE
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:NC
Mailing Address - Zip Code:27006-6651
Mailing Address - Country:US
Mailing Address - Phone:336-998-2427
Mailing Address - Fax:336-998-1088
Practice Address - Street 1:127 ROYAL TROON LANE
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6651
Practice Address - Country:US
Practice Address - Phone:336-998-2427
Practice Address - Fax:336-998-1088
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC91141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice