Provider Demographics
NPI:1558386557
Name:BARRETT G MOORE DDS PA
Entity Type:Organization
Organization Name:BARRETT G MOORE DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRETT
Authorized Official - Middle Name:G
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-342-3213
Mailing Address - Street 1:128 S TRYON ST
Mailing Address - Street 2:STE #860
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202
Mailing Address - Country:US
Mailing Address - Phone:704-342-3213
Mailing Address - Fax:704-342-4470
Practice Address - Street 1:128 S TRYON ST
Practice Address - Street 2:STE #860
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202
Practice Address - Country:US
Practice Address - Phone:704-342-3213
Practice Address - Fax:704-342-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC107468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty