Provider Demographics
NPI:1629597240
Name:JASON T. MOORE, D.D.S. AND ADAM T. DORSETT, D.D.S., PA
Entity Type:Organization
Organization Name:JASON T. MOORE, D.D.S. AND ADAM T. DORSETT, D.D.S., PA
Other - Org Name:HILLSDALE DENTAL-LEWISVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-608-3676
Mailing Address - Street 1:1341 LEWISVILLE CLEMMONS RD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27023-9635
Mailing Address - Country:US
Mailing Address - Phone:336-608-3676
Mailing Address - Fax:
Practice Address - Street 1:1341 LEWISVILLE CLEMMONS RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9635
Practice Address - Country:US
Practice Address - Phone:336-608-3676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty