Provider Demographics
NPI:1104224104
Name:MOORE, THERESA (RDH)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 S PARKER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2178
Mailing Address - Country:US
Mailing Address - Phone:303-755-6341
Mailing Address - Fax:303-873-9886
Practice Address - Street 1:1250 S PARKER RD STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2178
Practice Address - Country:US
Practice Address - Phone:303-755-6341
Practice Address - Fax:303-873-9886
Is Sole Proprietor?:No
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH000201990124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist