Individual
BRENT ALLEN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11630 OLIO RD, SUITE #100, FISHERS, IN 46037-7677
(317) 348-1354
(866) 511-4151
Mailing address
14575 LANSING PLACE, FISHERS, IN 46038
(317) 679-8207
(866) 511-4151
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12010751A
IN
Other
Enumeration date
11/09/2006
Last updated
03/25/2008
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