Provider Demographics
NPI:1720286362
Name:MCMOORE, SHORN D (DDS)
Entity Type:Individual
Prefix:
First Name:SHORN
Middle Name:D
Last Name:MCMOORE
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 1:401 BEECHAM DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1302
Mailing Address - Country:US
Mailing Address - Phone:804-918-0069
Mailing Address - Fax:
Practice Address - Street 1:421 BARNFIELD RD
Practice Address - Street 2:HAYNESVILLE CORRECTIONAL CENTER
Practice Address - City:HAYNESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22472
Practice Address - Country:US
Practice Address - Phone:804-333-3577
Practice Address - Fax:804-333-3826
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014118311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice