Provider Demographics
NPI:1619168861
Name:JAMES T MOORE, DDS, PC
Entity Type:Organization
Organization Name:JAMES T MOORE, DDS, PC
Other - Org Name:ST LOUIS SMILE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-298-7772
Mailing Address - Street 1:11520 SAINT CHARLES ROCK RD
Mailing Address - Street 2:SUTIE 205
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2732
Mailing Address - Country:US
Mailing Address - Phone:314-298-7772
Mailing Address - Fax:314-298-9895
Practice Address - Street 1:11520 SAINT CHARLES ROCK RD
Practice Address - Street 2:SUTIE 205
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2732
Practice Address - Country:US
Practice Address - Phone:314-298-7772
Practice Address - Fax:314-298-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty