Provider Demographics
NPI:1811066046
Name:MOORE, PATRICK MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:MICHAEL
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 1:2232 ST CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-1437
Mailing Address - Country:US
Mailing Address - Phone:330-385-0717
Mailing Address - Fax:330-385-0773
Practice Address - Street 1:2232 ST CLAIR AVE
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-1437
Practice Address - Country:US
Practice Address - Phone:330-385-0717
Practice Address - Fax:330-385-0773
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH200291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice