Individual
DR. CAROLYN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
257 COMMERCE DR, PEACHTREE CITY, GA 30269-1484
(770) 487-8896
Mailing address
257 COMMERCE DR, PEACHTREE CITY, GA 30269-1484
(770) 487-8896
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12708
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
569840586
—
GA
05
—
569840586A
—
GA
Enumeration date
01/03/2007
Last updated
07/08/2007
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