Provider Demographics
NPI:1992186415
Name:MOORE, BENJAMIN ROSS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ROSS
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 1:29 CROWS VIEW DR
Mailing Address - Street 2:APT 106
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-0048
Mailing Address - Country:US
Mailing Address - Phone:715-587-7025
Mailing Address - Fax:
Practice Address - Street 1:15 RAWLS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-6033
Practice Address - Country:US
Practice Address - Phone:715-587-7025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice