Provider Demographics
NPI:1871653899
Name:MOORE, PATRICK (DDS)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21970 BULVERDE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-2179
Mailing Address - Country:US
Mailing Address - Phone:210-496-7846
Mailing Address - Fax:210-497-7407
Practice Address - Street 1:21970 BULVERDE RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78259-2179
Practice Address - Country:US
Practice Address - Phone:210-496-7846
Practice Address - Fax:210-497-7407
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124711223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics