Individual
DR. KELLY JAMES MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6075 VANTAGE PL, ROCKFORD, IL 61107-5905
(815) 399-9040
(815) 399-9336
Mailing address
404 JAMES AVE, ROCKFORD, IL 61107-4626
(815) 399-7757
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
IL
Other
Enumeration date
09/01/2006
Last updated
07/08/2007
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