Provider Demographics
NPI:1487079133
Name:MOORE, RONALD R
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:R
Last Name:MOORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11012 N RADIO STATION RD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-1142
Mailing Address - Country:US
Mailing Address - Phone:864-882-0880
Mailing Address - Fax:864-882-0881
Practice Address - Street 1:11012 N RADIO STATION RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1142
Practice Address - Country:US
Practice Address - Phone:864-882-0880
Practice Address - Fax:864-882-0881
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist