Alex Moore, Dmd PC
Dentist, Endodontics in Rockford, IL. Organization (NPI-2).
NPI number1730676990
StatusActive
Last updated in NPPESApr 21, 2022
Details
- NPI
- 1730676990
- Entity type
- Organization (NPI-2)
- Legal business name
- Alex Moore, Dmd PC
- Organization subpart
- No
- Enumeration date
- Apr 13, 2018
- Certification date
- Apr 21, 2022
- Last updated
- Apr 21, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223E0200X | Dentist, Endodontics | – | – | Yes |
| 261QD0000X | Clinic/Center, Dental | – | – |
Practice location
6050 Brynwood Dr Ste 205Rockford, IL 61114
Phone 815-201-5955 · Fax 815-201-5956
Mailing address
6050 Brynwood Dr Ste 205Rockford, IL 61114-6579
Phone 815-201-5955 · Fax 815-201-5956
Other practice locations
350 S Northwest Hwy
Park Ridge, IL 60068-4216
Park Ridge, IL 60068-4216
Phone 847-823-4161
350 S Northwest Hwy Ste 116
Park Ridge, IL 60068-4262
Park Ridge, IL 60068-4262
Phone 847-823-4161
Authorized official
Alex Moore
Dentist
8156216060
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