Organization
DR. L.J. MOORE DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEE JOSEPH MOORE D.D.S (DENTIST/OWNER)
(773) 779-8900
Entity
Organization
Contact information
Practice address
2407 W 104TH ST, CHICAGO, IL 60655-1006
(773) 779-8900
(773) 779-2085
Mailing address
2407 W 104TH ST, CHICAGO, IL 60655-1006
(773) 779-8900
(773) 779-2085
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019014938
IL
Other
Enumeration date
10/24/2014
Last updated
10/24/2014
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