Provider Demographics
NPI:1508039603
Name:DAVID B. MOORE, DMD, PA
Entity Type:Organization
Organization Name:DAVID B. MOORE, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-879-4770
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-0022
Mailing Address - Country:US
Mailing Address - Phone:908-879-4770
Mailing Address - Fax:
Practice Address - Street 1:310 ROUTE 24
Practice Address - Street 2:BUILDING B, SUITE 1B
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2625
Practice Address - Country:US
Practice Address - Phone:908-879-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty