Provider Demographics
NPI:1245471564
Name:MOORE, JULIE (DMD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:DECARLO
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3416 OLANDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1372
Mailing Address - Country:US
Mailing Address - Phone:301-774-2683
Mailing Address - Fax:
Practice Address - Street 1:3912 E 10TH ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-8798
Practice Address - Country:US
Practice Address - Phone:301-774-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131201223G0001X
NC12331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice