Provider Demographics
NPI:1689688350
Name:MOORE, WILLIAM JEFFREY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JEFFREY
Last Name:MOORE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2726
Mailing Address - Country:US
Mailing Address - Phone:530-527-7800
Mailing Address - Fax:530-527-6178
Practice Address - Street 1:1010 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2726
Practice Address - Country:US
Practice Address - Phone:530-527-7800
Practice Address - Fax:530-527-6178
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0359511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA035951OtherCALIFORNIA DENTAL LICENSE
182850109OtherAMERICAN DENTAL ASSOC. #