Provider Demographics
NPI:1700024254
Name:MOORE, PATRICIA MARIE
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13706 W BELL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374
Mailing Address - Country:US
Mailing Address - Phone:623-584-9910
Mailing Address - Fax:623-584-9940
Practice Address - Street 1:13706 W BELL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374
Practice Address - Country:US
Practice Address - Phone:623-584-9910
Practice Address - Fax:623-584-9940
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant