Individual
DR. SHANE L MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2455 W INTERSTATE 40, AMARILLO, TX 79109-1852
(806) 350-5437
(806) 350-5438
Mailing address
2455 W INTERSTATE 40, AMARILLO, TX 79109-1852
(806) 350-5437
(806) 350-5438
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
18661
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1420292
UNITED CONCORDIA
TX
01
—
89D745
BLUECROSSBLUE SHIELD
TX
Enumeration date
11/20/2006
Last updated
07/08/2007
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