Individual
DR. MICHAEL BERNARD MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1427 RITCHIE STREET & COOK PARKWAY, OCEANA, WV 24870
(304) 682-6104
(304) 682-6157
Mailing address
PO BOX 1438, OCEANA, WV 24870-1438
(304) 682-6104
(304) 682-6157
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3199
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0134288000
—
WV
Enumeration date
10/25/2006
Last updated
09/15/2011
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