Provider Demographics
NPI:1841435203
Name:RICHARD W. MOORE DDS PC
Entity type:Organization
Organization Name:RICHARD W. MOORE DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:LE
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-255-1200
Mailing Address - Street 1:7931 NE HALSEY ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6755
Mailing Address - Country:US
Mailing Address - Phone:503-255-1200
Mailing Address - Fax:503-408-6856
Practice Address - Street 1:7931 NE HALSEY ST
Practice Address - Street 2:SUITE 305
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6755
Practice Address - Country:US
Practice Address - Phone:503-255-1200
Practice Address - Fax:503-408-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR663456225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR145023Medicare PIN