Provider Demographics
NPI:1801968714
Name:MOORE, ANDREW F (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:F
Last Name:MOORE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SHILOH ROAD
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-2620
Mailing Address - Country:US
Mailing Address - Phone:662-287-1171
Mailing Address - Fax:662-287-2575
Practice Address - Street 1:900 SHILOH ROAD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-2620
Practice Address - Country:US
Practice Address - Phone:662-287-1171
Practice Address - Fax:662-287-2575
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3010-971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660226Medicaid
ZIX782OtherBCBS OF MA
556295OtherUNITED CONCORDIA