Provider Demographics
NPI:1720894629
Name:HERITAGE MOORE - AMS, PLLC
Entity type:Organization
Organization Name:HERITAGE MOORE - AMS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-373-1660
Mailing Address - Street 1:121 PARK HILL DR STE A
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3357
Mailing Address - Country:US
Mailing Address - Phone:540-373-1660
Mailing Address - Fax:
Practice Address - Street 1:121 PARK HILL DR STE A
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3357
Practice Address - Country:US
Practice Address - Phone:540-373-1660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental