Provider Demographics
NPI:1568537868
Name:MOORE, JOE ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:ALLEN
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:P O BOX 69
Mailing Address - Street 2:
Mailing Address - City:SWEETWATER
Mailing Address - State:TN
Mailing Address - Zip Code:37874
Mailing Address - Country:US
Mailing Address - Phone:423-337-5045
Mailing Address - Fax:423-337-5044
Practice Address - Street 1:206 MAYES AVE
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TN
Practice Address - Zip Code:37874
Practice Address - Country:US
Practice Address - Phone:423-337-5045
Practice Address - Fax:423-337-5044
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS22991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0020476OtherBLUE CROSS BLUE SHIELD