Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 3812 | NC |
NPI | 1346375953 |
---|---|
Provider Name | Dr. James Brice Moore III |
First Address | Washington, NC 27889 |
Second Address | Greenville, NC 27834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |