Provider Demographics
NPI:1598091167
Name:MOORE, AISHA (DDS)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
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 1:636 CROWN POINTE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-4993
Mailing Address - Country:US
Mailing Address - Phone:803-329-4746
Mailing Address - Fax:803-329-4748
Practice Address - Street 1:636 CROWN POINTE LANE
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-4993
Practice Address - Country:US
Practice Address - Phone:803-329-4746
Practice Address - Fax:803-329-4748
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13812122300000X
DCDEN1000593122300000X
SC4665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist