Provider Demographics
NPI:1174938500
Name:MOORE, HEATHER MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
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 1:101 W CASCADE WAY SUITE 202
Mailing Address - Street 2:CASCADE DENTAL CARE
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6016
Mailing Address - Country:US
Mailing Address - Phone:509-466-9638
Mailing Address - Fax:509-466-8381
Practice Address - Street 1:101 W. CASCADE WAY SUITE 202
Practice Address - Street 2:CASCADE DENTAL CARE
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-6016
Practice Address - Country:US
Practice Address - Phone:509-466-9638
Practice Address - Fax:509-466-8381
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE604759961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice