Provider Demographics
NPI:1669590121
Name:THOMAS W. MOORMAN, D.D.S., P.C.
Entity type:Organization
Organization Name:THOMAS W. MOORMAN, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MOORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-483-6655
Mailing Address - Street 1:PO BOX 80067
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-8067
Mailing Address - Country:US
Mailing Address - Phone:770-483-6655
Mailing Address - Fax:770-760-0269
Practice Address - Street 1:1455 OLD MCDONOUGH HWY SE STE B
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5979
Practice Address - Country:US
Practice Address - Phone:770-483-6655
Practice Address - Fax:770-760-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty