Provider Demographics
NPI:1851423503
Name:WILMORE, ANNE MOE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MOE
Last Name:WILMORE
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 1:6108 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1822
Mailing Address - Country:US
Mailing Address - Phone:317-726-0106
Mailing Address - Fax:
Practice Address - Street 1:114 4TH ST
Practice Address - Street 2:
Practice Address - City:TIPTON
Practice Address - State:IN
Practice Address - Zip Code:46072-1851
Practice Address - Country:US
Practice Address - Phone:765-675-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010689A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist