Provider Demographics
NPI:1609910173
Name:MOORE, JR, JAMES PEYTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PEYTON
Last Name:MOORE, JR
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 1:101 CLEVELAND AVE
Mailing Address - Street 2:E-5
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-3700
Mailing Address - Country:US
Mailing Address - Phone:276-632-3963
Mailing Address - Fax:276-638-3204
Practice Address - Street 1:101 CLEVELAND AVE
Practice Address - Street 2:E-5
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-3700
Practice Address - Country:US
Practice Address - Phone:276-632-3963
Practice Address - Fax:276-638-3204
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010068861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0401006886OtherLICENSE #