Provider Demographics
NPI:1720399561
Name:MOLTA MOORE, DIANA CAROLINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CAROLINA
Last Name:MOLTA 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 1:349 EARNIE LANE
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540
Mailing Address - Country:US
Mailing Address - Phone:832-704-0661
Mailing Address - Fax:919-825-3130
Practice Address - Street 1:349 EARNIE LANE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540
Practice Address - Country:US
Practice Address - Phone:832-704-0661
Practice Address - Fax:919-825-3130
Is Sole Proprietor?:No
Enumeration Date:2010-06-26
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0389061223G0001X
MD150271223G0001X
NC2601301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice