Individual
ALTHEA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2020 W HARRISON ST, CHICAGO, IL 60612-3741
(312) 572-4785
Mailing address
1645 COTTAGE GROVE AVE, FORD HEIGHTS, IL 60411-3818
(312) 572-4785
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
020.011098
IL
Other
Enumeration date
08/07/2020
Last updated
08/07/2020
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