Individual
DR. TANISHA R MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
221 E HOME RD, SPRINGFIELD, OH 45503-2666
(937) 399-4470
(937) 399-3338
Mailing address
221 E HOME RD, SPRINGFIELD, OH 45503-2666
(937) 399-4470
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
23622
OH
122300000X
Dentist
8087
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CS1632300125
—
OH
Enumeration date
02/20/2007
Last updated
03/23/2017
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