Provider Demographics
NPI:1730264730
Name:MOORE, CLARIE BRYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:CLARIE
Middle Name:BRYAN
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 1:1717 PULASKI PIKE NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35816-1629
Mailing Address - Country:US
Mailing Address - Phone:256-539-2020
Mailing Address - Fax:256-539-7526
Practice Address - Street 1:1717 PULASKI PIKE NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35816-1629
Practice Address - Country:US
Practice Address - Phone:256-539-2020
Practice Address - Fax:256-539-7526
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3606122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist