Provider Demographics
NPI:1982706917
Name:MOORE, DAVID HOLLAND (DDS, MS, PA)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HOLLAND
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS, MS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 S KINGS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1806
Mailing Address - Country:US
Mailing Address - Phone:704-377-3694
Mailing Address - Fax:
Practice Address - Street 1:411 BILLINGSLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1046
Practice Address - Country:US
Practice Address - Phone:704-377-3694
Practice Address - Fax:704-377-9790
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890110VMedicaid
NC890110VMedicaid