# DAVID E MOORE DDS, PS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083079164
- **Authorized official:** CHARLENE G JOHNSON (OFFICE CORDINATOR)
- **Authorized official phone:** (509) 457-4532

## Contact information

- **Practice address:** 11 N 11TH AVE STE 107, YAKIMA, WA 98902-3085
- **Practice address phone:** (509) 457-4532
- **Practice address fax:** (509) 453-0175
- **Mailing address:** 11 N 11TH AVE STE 107, YAKIMA, WA 98902-3085
- **Mailing address phone:** (509) 457-4532
- **Mailing address fax:** (509) 453-0175

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 60381727 | WA | Yes |

## Other

- **Enumeration date:** 12/16/2015
- **Last updated:** 12/16/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 2029904 | — | WA |