Provider Demographics
NPI:1891838850
Name:MOORE, CLARKE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLARKE
Middle Name:C
Last Name:MOORE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CLARKE
Other - Middle Name:C
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9617 WINDOM POINT AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7827
Mailing Address - Country:US
Mailing Address - Phone:702-228-1625
Mailing Address - Fax:702-260-1825
Practice Address - Street 1:9580 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8807
Practice Address - Country:US
Practice Address - Phone:702-242-4680
Practice Address - Fax:702-304-9996
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV27051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice