Provider Demographics
NPI:1992773022
Name:MOORE, LARRY J (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:MOORE
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:4200 CHINO HILLS PKWY
Mailing Address - Street 2:#805
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3776
Mailing Address - Country:US
Mailing Address - Phone:909-606-0160
Mailing Address - Fax:909-606-4061
Practice Address - Street 1:4200 CHINO HILLS PKWY
Practice Address - Street 2:#805
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-3776
Practice Address - Country:US
Practice Address - Phone:909-606-0160
Practice Address - Fax:909-606-4061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA299311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery