Individual
MRS. EDITH MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
37944 CHURCH AVE, DADE CITY, FL 33525
(352) 518-2000
(352) 518-0218
Mailing address
PO BOX 232, DADE CITY, FL 33526-0232
(352) 518-2000
(352) 567-1974
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN10803
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
077641601
—
FL
Enumeration date
03/17/2006
Last updated
05/23/2008
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