Provider Demographics
NPI:1972658029
Name:MOORE, DAVID THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
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 1:3900 EUBANK BLVD. NE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3427
Mailing Address - Country:US
Mailing Address - Phone:505-293-6125
Mailing Address - Fax:505-293-6130
Practice Address - Street 1:3900 EUBANK BLVD. NE
Practice Address - Street 2:SUITE #5
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3427
Practice Address - Country:US
Practice Address - Phone:505-293-6125
Practice Address - Fax:505-293-6130
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD18441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice