Provider Demographics
NPI:1972012748
Name:PEARL CDA-MOORE, DDS, LLC
Entity Type:Organization
Organization Name:PEARL CDA-MOORE, DDS, LLC
Other - Org Name:PEARL COSMETIC DENTISTRY & AESTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:MONET
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-914-8338
Mailing Address - Street 1:112 JEFFERSON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1861
Mailing Address - Country:US
Mailing Address - Phone:614-914-8338
Mailing Address - Fax:614-914-8392
Practice Address - Street 1:112 JEFFERSON AVE STE 2
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1861
Practice Address - Country:US
Practice Address - Phone:614-914-8338
Practice Address - Fax:614-917-8392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty