Provider Demographics
NPI:1689894388
Name:MOORE, TERRANCE HENRY SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:HENRY
Last Name:MOORE
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1987 MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-1242
Mailing Address - Country:US
Mailing Address - Phone:248-737-6055
Mailing Address - Fax:248-398-4553
Practice Address - Street 1:28926 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0942
Practice Address - Country:US
Practice Address - Phone:248-398-9528
Practice Address - Fax:248-398-4553
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI0122321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice