Provider Demographics
NPI:1316156839
Name:MOORE, CAROLINE PIMENTEL (DMD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:PIMENTEL
Last Name:MOORE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 E PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-3932
Mailing Address - Country:US
Mailing Address - Phone:619-479-5533
Mailing Address - Fax:619-470-6260
Practice Address - Street 1:3110 E PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-3932
Practice Address - Country:US
Practice Address - Phone:619-479-5533
Practice Address - Fax:619-470-6260
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44951122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist