Provider Demographics
NPI:1790916021
Name:MOORE, DESIREE LENEE (DMD)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:LENEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:LENEE
Other - Last Name:MOSIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:6962 TYLERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-779-9800
Mailing Address - Fax:513-779-8845
Practice Address - Street 1:1724 NEBRASKA AVE
Practice Address - Street 2:BLDG 1608
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8939
Practice Address - Country:US
Practice Address - Phone:573-596-0388
Practice Address - Fax:573-596-0410
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023058122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist