Provider Demographics
NPI:1730108838
Name:MOORE, PETER STEVEN (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:STEVEN
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 1:11426 GADZOOKS DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-6912
Mailing Address - Country:US
Mailing Address - Phone:801-545-0114
Mailing Address - Fax:
Practice Address - Street 1:7555 CENTER VIEW CT
Practice Address - Street 2:#103
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1970
Practice Address - Country:US
Practice Address - Phone:801-748-4151
Practice Address - Fax:801-748-0307
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9937508999221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice