Provider Demographics
NPI:1013331560
Name:GARY MOORE DDS LTD
Entity Type:Organization
Organization Name:GARY MOORE DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-694-0400
Mailing Address - Street 1:5910 STETSON HILLS BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3580
Mailing Address - Country:US
Mailing Address - Phone:719-694-0400
Mailing Address - Fax:719-694-0240
Practice Address - Street 1:5910 STETSON HILLS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3580
Practice Address - Country:US
Practice Address - Phone:719-694-0400
Practice Address - Fax:719-694-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty