Provider Demographics
NPI:1881456473
Name:MOORE, MOLLY MARIE (RDH)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARIE
Last Name:MOORE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90027 OCEAN DR
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-7125
Mailing Address - Country:US
Mailing Address - Phone:503-440-1837
Mailing Address - Fax:
Practice Address - Street 1:2185 SE 12TH PL
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:OR
Practice Address - Zip Code:97146-9311
Practice Address - Country:US
Practice Address - Phone:503-861-6243
Practice Address - Fax:503-861-6358
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4477124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist