Individual
DAISY KIT MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS PA
Contact information
Practice address
1101 E STATE HIGHWAY 114, SUITE 104, SOUTHLAKE, TX 76092-5233
(817) 410-7373
(817) 416-9383
Mailing address
1101 E STATE HIGHWAY 114, SUITE 104, SOUTHLAKE, TX 76092-5233
(817) 410-7373
(817) 416-9383
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17839
TX
Other
Enumeration date
09/16/2005
Last updated
04/09/2014
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