Provider Demographics
NPI:1962749283
Name:MOORE, MARY HELEN PENDER (DDS)
Entity type:Individual
Prefix:DR
First Name:MARY HELEN
Middle Name:PENDER
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 1:11217 W POINT DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2873
Mailing Address - Country:US
Mailing Address - Phone:865-675-8877
Mailing Address - Fax:
Practice Address - Street 1:11217 W POINT DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2873
Practice Address - Country:US
Practice Address - Phone:865-675-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000007099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist