Provider Demographics
NPI:1447318803
Name:MOORE, JEFFREY MORGAN (DDS)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MORGAN
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11765 MCMINNVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:WALLING
Mailing Address - State:TN
Mailing Address - Zip Code:38587-5040
Mailing Address - Country:US
Mailing Address - Phone:931-657-5204
Mailing Address - Fax:931-657-2134
Practice Address - Street 1:11765 MCMINNVILLE HWY
Practice Address - Street 2:
Practice Address - City:WALLING
Practice Address - State:TN
Practice Address - Zip Code:38587
Practice Address - Country:US
Practice Address - Phone:931-657-5204
Practice Address - Fax:931-657-2134
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 4172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist