Individual
DR. ETHAN EMBREY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
430 BROAD ST, COLUMBIA, MS 39429-3006
(601) 736-7125
Mailing address
430 BROAD ST, COLUMBIA, MS 39429-3006
(601) 736-7125
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4212-21
MS
Other
Enumeration date
06/14/2021
Last updated
07/07/2025
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