1992186415 NPI number — DR. BENJAMIN ROSS MOORE D.D.S.

Table of content: DR. BENJAMIN ROSS MOORE D.D.S. (NPI 1992186415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992186415 NPI number — DR. BENJAMIN ROSS MOORE D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOORE
Provider First Name:
BENJAMIN
Provider Middle Name:
ROSS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

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:
1992186415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 CROWS VIEW DR
Provider Second Line Business Mailing Address:
APT 106
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-0048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-587-7025
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 RAWLS RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ANGIER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27501-6033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-587-7025
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  10065 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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