Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 11523 | MT |
NPI | 1033678412 |
---|---|
Provider Name | Michael J Moore |
First Address | Havre, MT 59501-4119 |
Second Address | Harlem, MT 59526-9455 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2019 |
Last Update Date | 15/03/2019 |