Individual
MATTHEW MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
8840 BLAKENEY PROFESSIONAL DR STE 300, CHARLOTTE, NC 28277-6749
(704) 716-9840
Mailing address
8840 BLAKENEY PROFESSIONAL DR STE 300, CHARLOTTE, NC 28277-6749
(704) 716-9840
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0000011693
TN
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
13163
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/08/2020
Last updated
07/02/2025
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