Provider Demographics
NPI:1538326517
Name:ANDREW L MOORE JR MS PC
Entity Type:Organization
Organization Name:ANDREW L MOORE JR MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-659-7515
Mailing Address - Street 1:PO BOX 968
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555
Mailing Address - Country:US
Mailing Address - Phone:540-659-7515
Mailing Address - Fax:540-659-7515
Practice Address - Street 1:2063 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE ONE
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:540-659-7515
Practice Address - Fax:540-659-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0410060501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA686682OtherCARENET
VA104019OtherUNITED CON TRICARE
VA291871OtherANTHEM
VA7804148OtherSMILES