Provider Demographics
NPI:1851698245
Name:MOORE, AMY JO (RDHAP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JO
Last Name:MOORE
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36124 42ND ST E
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93552-6208
Mailing Address - Country:US
Mailing Address - Phone:818-726-5458
Mailing Address - Fax:
Practice Address - Street 1:36124 42ND ST E
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93552-6208
Practice Address - Country:US
Practice Address - Phone:818-726-5458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-21
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP 329124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist