Provider Demographics
NPI:1548386824
Name:MOORE, TERRY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
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 1:500 BOYD COURT
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020
Mailing Address - Country:US
Mailing Address - Phone:817-270-2177
Mailing Address - Fax:817-270-2174
Practice Address - Street 1:500 BOYD COURT
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76020
Practice Address - Country:US
Practice Address - Phone:817-270-2177
Practice Address - Fax:817-270-2174
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics