Individual
RONALD MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
222 S SUMMIT AVE, PRESCOTT, AZ 86303-3780
(928) 445-0582
Mailing address
2430 N SHADOW VALLEY RANCH TRL, PRESCOTT, AZ 86305-6903
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1717
AZ
Other
Enumeration date
05/10/2011
Last updated
05/10/2011
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