Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 3658 | ME |
NPI | 1669511374 |
---|---|
Provider Name | Dr. Robert Danny Moore |
First Address | Bangor, ME 04401-3620 |
Second Address | Bangor, ME 04401-3620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 08/07/2007 |