Provider Demographics
NPI:1013987114
Name:MOORE, WHITNEY MONET (DDS)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:MONET
Last Name:MOORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 E FALL CREEK PARKWAY NORTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3858
Mailing Address - Country:US
Mailing Address - Phone:317-513-8669
Mailing Address - Fax:
Practice Address - Street 1:3232 E FALL CREEK PARKWAY NORTH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3858
Practice Address - Country:US
Practice Address - Phone:317-513-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010224A122300000X
OH30-0225971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200275740Medicaid
IN200275740Medicaid
INU89954Medicare UPIN