Provider Demographics
NPI:1295125797
Name:JAMES D. MOORE, DDS, PROFESSIONAL LLC
Entity type:Organization
Organization Name:JAMES D. MOORE, DDS, PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-769-6564
Mailing Address - Street 1:800 S CAMINO DEL RIO
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-6898
Mailing Address - Country:US
Mailing Address - Phone:970-259-2264
Mailing Address - Fax:
Practice Address - Street 1:555 S CAMINO DEL RIO STE A2
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-6851
Practice Address - Country:US
Practice Address - Phone:970-259-2264
Practice Address - Fax:970-259-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN 000100041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty