Individual
DR. JOHN GREGORY MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1160 JOHNSON AVE, SUITE 104, BRIDGEPORT, WV 26330-1487
(304) 842-2361
Mailing address
1160 JOHNSON AVE, SUITE 104, BRIDGEPORT, WV 26330-1487
(304) 842-2361
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2794
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0137163000
—
WV
01
—
94661
UNITED CONCORDIA
WA
Enumeration date
11/01/2006
Last updated
07/08/2007
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