Individual
GWENDOLYN F MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
4233 HIGHWAY 8 EAST, CLEVELAND, MS 38732
(662) 843-6356
Mailing address
424 JOANN CIRCLE, GREENVILLE, MS 38704
(662) 931-1022
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2950-96
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660163
—
MS
Enumeration date
04/10/2008
Last updated
04/10/2008
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