Provider Demographics
NPI:1730207127
Name:MOORE, JOHN W (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:MOORE
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4263 NE 73RD ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6033
Mailing Address - Country:US
Mailing Address - Phone:206-525-0914
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 840
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1769
Practice Address - Country:US
Practice Address - Phone:206-623-2192
Practice Address - Fax:206-623-2195
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA46911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics