Provider Demographics
NPI:1710275706
Name:MOORE, WILLIAM D JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:MOORE
Suffix:JR
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 1:1961 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-1204
Mailing Address - Country:US
Mailing Address - Phone:706-453-2351
Mailing Address - Fax:706-453-4714
Practice Address - Street 1:1961 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:GA
Practice Address - Zip Code:30642-1204
Practice Address - Country:US
Practice Address - Phone:706-453-2351
Practice Address - Fax:706-453-4714
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO142571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice