Individual
MRS. BRENDA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
7223 MISSISSIPPI AVE BUILDING 2157, FORT POLK, LA 71459
(337) 531-4854
Mailing address
360 FAIRWAY CT, FORT POLK, LA 71459-3121
(907) 854-9761
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DENH966
AK
Other
Enumeration date
03/30/2018
Last updated
03/30/2018
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