Individual
CHARLES MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1710 TROLLEY RD STE B, SUMMERVILLE, SC 29485-8281
(843) 871-0711
Mailing address
1710 TROLLEY RD STE B, SUMMERVILLE, SC 29485-8281
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8530
SC
Other
Enumeration date
08/13/2014
Last updated
09/02/2015
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