Individual
DR. GRACE ELIZABETH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1610 W FULLERTON AVE, CHICAGO, IL 60614-2659
(630) 423-9646
Mailing address
361 MILLRIDGE DR, INDIANAPOLIS, IN 46290-1117
(317) 371-0555
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
032763
IL
Other
Enumeration date
07/16/2020
Last updated
07/16/2020
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