Provider Demographics
NPI:1801067327
Name:DAVID H. MOORE DDS, MS, PA
Entity type:Organization
Organization Name:DAVID H. MOORE DDS, MS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:MYRICK
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-377-3694
Mailing Address - Street 1:411 BILLINGSLEY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211
Mailing Address - Country:US
Mailing Address - Phone:704-547-8438
Mailing Address - Fax:704-547-9323
Practice Address - Street 1:10320 MALLARD CREEK RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-9756
Practice Address - Country:US
Practice Address - Phone:704-547-8438
Practice Address - Fax:704-547-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907730Medicaid
NC5903366Medicaid
NC5905575Medicaid
NC89902RTMedicaid
NC8996034Medicaid
NC5905114Medicaid