Organization
KELLY J. MOORE D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLY JAMES MOORE DDS (DENTIST/OWNER)
(815) 399-9040
Entity
Organization
Contact information
Practice address
6075 VANTAGE PL, ROCKFORD, IL 61107-5905
(815) 399-9040
(815) 399-9336
Mailing address
6075 VANTAGE PL, ROCKFORD, IL 61107-5905
(815) 399-9040
(815) 399-9336
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
060-003341
IL
Other
Enumeration date
09/01/2006
Last updated
10/10/2008
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