Provider Demographics
NPI:1548473226
Name:MOORE, BRIAN DUANE (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DUANE
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 27539
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-0539
Mailing Address - Country:US
Mailing Address - Phone:215-242-5797
Mailing Address - Fax:215-242-1171
Practice Address - Street 1:7156 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19150-3428
Practice Address - Country:US
Practice Address - Phone:215-242-5797
Practice Address - Fax:215-242-1171
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026705L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics