Provider Demographics
NPI:1992494652
Name:MOORE, CAITLIN ANNE (DDS)
Entity type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:ANNE
Last Name:MOORE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 140 VILLAGE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6196
Mailing Address - Country:US
Mailing Address - Phone:108-488-2294
Mailing Address - Fax:
Practice Address - Street 1:332 140 VILLAGE RD STE 4
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6196
Practice Address - Country:US
Practice Address - Phone:108-488-2294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD181981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program