Individual
DR. FREDERICK THOMAS MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
173 ASHLEY AVE, BSB 249,, CHARLESTON, SC 29425-8908
(843) 792-0693
(843) 792-1280
Mailing address
173 ASHLEY AVE, BSB 249, PO BOX 250507, CHARLESTON, SC 29425-8908
(843) 792-0693
(843) 792-1280
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
17
SC
Other
Enumeration date
01/09/2008
Last updated
01/09/2008
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