Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 1080 | FL |
NPI | 1033474176 |
---|---|
Provider Name | Ronda Moore |
First Address | Gainesville, FL 32610-0426 |
Second Address | Gainesville, FL 32610-3006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2012 |
Last Update Date | 04/07/2012 |