Provider Demographics
NPI:1457424699
Name:MOORE, GENE P (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:P
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 EUCLID AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3612
Mailing Address - Country:US
Mailing Address - Phone:619-263-6683
Mailing Address - Fax:619-263-0048
Practice Address - Street 1:286 EUCLID AVE STE 201
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3612
Practice Address - Country:US
Practice Address - Phone:619-263-6683
Practice Address - Fax:619-263-0048
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA204191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB20419 01OtherDENTI-CAL