Provider Demographics
NPI:1295746501
Name:MOORE, KARA GRIFFIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:GRIFFIN
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:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:GA
Mailing Address - Zip Code:31032-0670
Mailing Address - Country:US
Mailing Address - Phone:478-986-6821
Mailing Address - Fax:478-986-3253
Practice Address - Street 1:242 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:GA
Practice Address - Zip Code:31032-5430
Practice Address - Country:US
Practice Address - Phone:478-986-6821
Practice Address - Fax:478-986-3253
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA130801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice