Provider Demographics
NPI:1548497712
Name:MOORE-EASLEY, CHRISTINA (DENTAL ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:
Last Name:MOORE-EASLEY
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CHILDRENS PLZ
Mailing Address - Street 2:SUITE 2070
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-1898
Mailing Address - Country:US
Mailing Address - Phone:937-641-3455
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDRENS PLZ
Practice Address - Street 2:SUITE 2070
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1898
Practice Address - Country:US
Practice Address - Phone:937-641-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0656126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant