Provider Demographics
NPI:1801066287
Name:MOORE, BARRETT G (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:BARRETT
Middle Name:G
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S TRYON ST
Mailing Address - Street 2:SUITE 860
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-5001
Mailing Address - Country:US
Mailing Address - Phone:704-342-3213
Mailing Address - Fax:704-342-4470
Practice Address - Street 1:128 S TRYON ST
Practice Address - Street 2:SUITE 860
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-5001
Practice Address - Country:US
Practice Address - Phone:704-342-3213
Practice Address - Fax:704-342-4470
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist