Provider Demographics
NPI:1710288873
Name:HUNTER-MOORE, JACQUELYN MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:MARIE
Last Name:HUNTER-MOORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 4TH ST
Mailing Address - Street 2:B
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-5819
Mailing Address - Country:US
Mailing Address - Phone:601-693-4878
Mailing Address - Fax:601-693-4337
Practice Address - Street 1:2310 4TH ST
Practice Address - Street 2:STE. B
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-5819
Practice Address - Country:US
Practice Address - Phone:601-693-4878
Practice Address - Fax:601-693-4337
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2678-921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660029OtherORGANIZATION NPI 1871706564