Provider Demographics
NPI:1215139464
Name:W.JIM MOORE, JR. D.D.S.,LTD.
Entity type:Organization
Organization Name:W.JIM MOORE, JR. D.D.S.,LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:W.
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:870-536-2650
Mailing Address - Street 1:3024 S OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-5438
Mailing Address - Country:US
Mailing Address - Phone:870-536-2650
Mailing Address - Fax:870-536-3820
Practice Address - Street 1:3024 S OLIVE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-5438
Practice Address - Country:US
Practice Address - Phone:870-536-2650
Practice Address - Fax:870-536-3820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty