Provider Demographics
NPI:1396946513
Name:MOORE, YOLANDA RENEE (DDS)
Entity type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:RENEE
Last Name:MOORE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5230 MCGINNIS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3921
Mailing Address - Country:US
Mailing Address - Phone:678-527-1130
Mailing Address - Fax:678-527-1135
Practice Address - Street 1:5230 MCGINNIS FERRY RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3921
Practice Address - Country:US
Practice Address - Phone:678-527-1130
Practice Address - Fax:678-527-1135
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GADN0138031223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program