Provider Demographics
NPI:1194572339
Name:MOORE, RANDI (PHDHP)
Entity type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1741 SILO HILL LN
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1151
Mailing Address - Country:US
Mailing Address - Phone:484-823-7768
Mailing Address - Fax:
Practice Address - Street 1:1741 SILO HILL LN
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1151
Practice Address - Country:US
Practice Address - Phone:484-823-7768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH001181124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist