Provider Demographics
NPI:1336261551
Name:MOORE, E. DREW (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:E.
Middle Name:DREW
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 VILLAGE PKWY STE 630
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VLG
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3299
Mailing Address - Country:US
Mailing Address - Phone:972-966-2500
Mailing Address - Fax:972-471-9833
Practice Address - Street 1:2820 VILLAGE PKWY STE 630
Practice Address - Street 2:
Practice Address - City:HIGHLAND VLG
Practice Address - State:TX
Practice Address - Zip Code:75077-3299
Practice Address - Country:US
Practice Address - Phone:972-966-2500
Practice Address - Fax:972-471-9833
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163731223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics