Provider Demographics
NPI:1396952735
Name:MOORE, CINDY CASAVANT (DMD)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:CASAVANT
Last Name:MOORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CINDY
Other - Middle Name:MOORE
Other - Last Name:HENDLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1107 CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-1672
Mailing Address - Country:US
Mailing Address - Phone:850-527-6329
Mailing Address - Fax:850-215-1363
Practice Address - Street 1:2407 W 11TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1634
Practice Address - Country:US
Practice Address - Phone:850-215-1353
Practice Address - Fax:850-215-1363
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL83831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice