# MOORE DENTAL PC

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

## Provider details

- **NPI number:** 1205217049
- **Authorized official:** CHARZATTA MOORE (PRESIDENT)
- **Authorized official phone:** (586) 558-8004

## Contact information

- **Practice address:** 511 W 8 MILE RD, DETROIT, MI 48203-1004
- **Practice address phone:** (313) 454-4800
- **Mailing address:** 27201 RYAN RD, WARREN, MI 48092-5127

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2901014832 | MI | Yes |

## Other

- **Enumeration date:** 06/17/2015
- **Last updated:** 06/17/2015