Individual
DR. SUSANNE REYNOLDS MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1149 OLD FANNIN RD, SUITE 26, BRANDON, MS 39047
(601) 992-7972
(601) 992-7972
Mailing address
1149 OLD FANNIN ROAD, SUITE 26, BRANDON, MS 39047
(601) 992-7972
(601) 992-7972
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
304598
MS
Other
Enumeration date
02/16/2007
Last updated
07/08/2007
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