1801067327 NPI number — DAVID H. MOORE DDS, MS, PA

Table of content: (NPI 1801067327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801067327 NPI number — DAVID H. MOORE DDS, MS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID H. MOORE DDS, MS, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801067327
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 BILLINGSLEY RD
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-547-8438
Provider Business Mailing Address Fax Number:
704-547-9323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10320 MALLARD CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-9756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-547-8438
Provider Business Practice Location Address Fax Number:
704-547-9323
Provider Enumeration Date:
03/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
BRANDI
Authorized Official Middle Name:
MYRICK
Authorized Official Title or Position:
ACCOUNT COORDINATOR
Authorized Official Telephone Number:
704-377-3694

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5907730 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5903366 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5905575 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89902RT , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8996034 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5905114 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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