Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN012955 | GA |
NPI | 1013930338 |
---|---|
Provider Name | Margaret Graham Moore |
First Address | Macon, GA 31210-3097 |
Second Address | Warner Robins, GA 31088-0520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 09/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
494727658A | (05) | GA |