Provider Demographics
NPI:1902472012
Name:MOORE, BARBARA ALLISON (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ALLISON
Last Name:MOORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1562 MILL SPRING DR APT G04
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-4544
Mailing Address - Country:US
Mailing Address - Phone:803-235-2182
Mailing Address - Fax:
Practice Address - Street 1:1147 STONECREST BLVD STE 105
Practice Address - Street 2:
Practice Address - City:TEGA CAY
Practice Address - State:SC
Practice Address - Zip Code:29708-6606
Practice Address - Country:US
Practice Address - Phone:803-547-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-29
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9961122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist