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Organization
ANDREW L MOORE JR MS PC
Active
Organization
ANDREW L MOORE JR MS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW LEWIS MOORE JR. DDS (OWNER)
(540) 659-7515
Entity
Organization
Contact information
Practice address
2063 JEFFERSON DAVIS HWY, SUITE ONE, STAFFORD, VA 22554
(540) 659-7515
(540) 659-7515
Mailing address
PO BOX 968, STAFFORD, VA 22555
(540) 659-7515
(540) 659-7515
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
041006050
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104019
UNITED CON TRICARE
VA
01
—
291871
ANTHEM
VA
01
—
686682
CARENET
VA
01
—
7804148
SMILES
VA
Enumeration date
05/19/2008
Last updated
05/19/2008
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