Provider Demographics
NPI:1942367859
Name:MOORE, HENRY DUNBAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:DUNBAR
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 1:1111 E. 87TH STREET
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619
Mailing Address - Country:US
Mailing Address - Phone:773-374-9778
Mailing Address - Fax:773-374-9013
Practice Address - Street 1:1111 E 87TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7038
Practice Address - Country:US
Practice Address - Phone:773-374-9778
Practice Address - Fax:773-374-9013
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19187371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice