Provider Demographics
NPI:1619087558
Name:MOORE, ERNEST HOUSTON (DD S)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:HOUSTON
Last Name:MOORE
Suffix:
Gender:M
Credentials:DD S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9545 FM 1836
Mailing Address - Street 2:
Mailing Address - City:KAUFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75142-6930
Mailing Address - Country:US
Mailing Address - Phone:972-962-6388
Mailing Address - Fax:214-368-8810
Practice Address - Street 1:302 N 3RD ST
Practice Address - Street 2:
Practice Address - City:MABANK
Practice Address - State:TX
Practice Address - Zip Code:75147-8611
Practice Address - Country:US
Practice Address - Phone:903-887-4405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8211122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Yes122300000XDental ProvidersDentist