Provider Demographics
NPI:1851390900
Name:MOORE, PAMELA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:A
Last Name: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 1:1524 INDEPENDENCE PKWY
Mailing Address - Street 2:SUITE A1/B
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6406
Mailing Address - Country:US
Mailing Address - Phone:972-398-1996
Mailing Address - Fax:972-398-8475
Practice Address - Street 1:1524 INDEPENDENCE PKWY
Practice Address - Street 2:SUITE A1/B
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6406
Practice Address - Country:US
Practice Address - Phone:972-398-1996
Practice Address - Fax:972-398-8475
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18697122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist