Provider Demographics
NPI:1922270404
Name:MOORE DENTISTRY, INC.
Entity Type:Organization
Organization Name:MOORE DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-348-1354
Mailing Address - Street 1:14575 LANSING PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-5273
Mailing Address - Country:US
Mailing Address - Phone:317-679-8207
Mailing Address - Fax:866-511-4151
Practice Address - Street 1:11630 OLIO RD
Practice Address - Street 2:SUITE #100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7677
Practice Address - Country:US
Practice Address - Phone:317-348-1354
Practice Address - Fax:866-511-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010751A261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental