Provider Demographics
NPI:1780733907
Name:MOORE, MICHAEL GERALD (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GERALD
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 1:13810 JOHN AUDUBON PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-486-9222
Mailing Address - Fax:281-486-8700
Practice Address - Street 1:13810 JOHN AUDUBON PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-486-9222
Practice Address - Fax:281-486-8700
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist