Provider Demographics
NPI:1063264075
Name:MOORE, STEVEN BARRETT II (DMD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:BARRETT
Last Name:MOORE
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5613 N WOLF CRK
Mailing Address - Street 2:
Mailing Address - City:LOVELY
Mailing Address - State:KY
Mailing Address - Zip Code:41231-8964
Mailing Address - Country:US
Mailing Address - Phone:606-471-5454
Mailing Address - Fax:
Practice Address - Street 1:1983 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FT WRIGHT
Practice Address - State:KY
Practice Address - Zip Code:41011-2607
Practice Address - Country:US
Practice Address - Phone:859-415-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11113122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist