Provider Demographics
NPI:1578726279
Name:MOORE, CLARISSA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:M
Last Name:MOORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13922 ESTATE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-5951
Mailing Address - Country:US
Mailing Address - Phone:703-754-7788
Mailing Address - Fax:703-754-7740
Practice Address - Street 1:13922 ESTATE MANOR DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-5951
Practice Address - Country:US
Practice Address - Phone:703-754-7788
Practice Address - Fax:703-754-7740
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412178122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist