Provider Demographics
NPI:1285743005
Name:MOORE, ALAN BOYD (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BOYD
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 1:2911 MEDICAL ARTS STREET #5
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-3302
Mailing Address - Country:US
Mailing Address - Phone:512-478-7700
Mailing Address - Fax:512-478-7715
Practice Address - Street 1:2911 MEDICAL ARTS STREET #5
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3302
Practice Address - Country:US
Practice Address - Phone:512-478-7700
Practice Address - Fax:512-478-7715
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice