Provider Demographics
NPI:1952318883
Name:MOORE, DARWIN DOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARWIN
Middle Name:DOD
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 1:4109 MEEKS DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77632-4511
Mailing Address - Country:US
Mailing Address - Phone:409-882-9025
Mailing Address - Fax:409-886-5666
Practice Address - Street 1:4109 MEEKS DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77632-4511
Practice Address - Country:US
Practice Address - Phone:409-882-9025
Practice Address - Fax:409-886-5666
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice