Individual
DUANE STEPHEN MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DENTIST
Contact information
Practice address
2026 OLYMPIC HWY N, SUITE 101, SHELTON, WA 98584-4156
(360) 432-8379
(360) 432-0526
Mailing address
2026 OLYMPIC HWY N, SUITE 101, SHELTON, WA 98584-4156
(360) 432-8379
(360) 432-0526
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00008271
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5045075
—
WA
Enumeration date
02/22/2007
Last updated
07/09/2007
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