Provider Demographics
NPI:1790812816
Name:MOORE, DEAN L (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:L
Last Name:MOORE
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Gender:M
Credentials:DPM
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Mailing Address - Street 1:1021 COSTA PACIFICA WAY
Mailing Address - Street 2:UNIT 2213
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-2195
Mailing Address - Country:US
Mailing Address - Phone:619-633-8584
Mailing Address - Fax:760-231-9135
Practice Address - Street 1:16633 DALLAS PKWY
Practice Address - Street 2:SUITE 600
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-6816
Practice Address - Country:US
Practice Address - Phone:619-633-8584
Practice Address - Fax:760-231-9135
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-11-10
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Provider Licenses
StateLicense IDTaxonomies
TX1700213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist