Provider Demographics
NPI:1497756027
Name:MOORE, THEODORE ENGLISH (DDS MS)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:ENGLISH
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9896 ROSEMONT AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-799-3994
Mailing Address - Fax:303-799-6005
Practice Address - Street 1:9896 ROSEMONT AVE
Practice Address - Street 2:STE 204
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-799-3994
Practice Address - Fax:303-799-6005
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics