Provider Demographics
NPI:1013930338
Name:MOORE, MARGARET GRAHAM (DMD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:GRAHAM
Last Name:MOORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 OBERON LN
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-3097
Mailing Address - Country:US
Mailing Address - Phone:478-333-3636
Mailing Address - Fax:478-333-6399
Practice Address - Street 1:900 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-0520
Practice Address - Country:US
Practice Address - Phone:478-333-3636
Practice Address - Fax:478-333-6399
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0129551223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA494727658AMedicaid