| Dr. L.j. Moore Dds Pc | |
|
2407 W 104th St Chicago IL 60655-1006 | |
| (773) 779-8900 | |
| (773) 779-2085 |
| Full Name | Dr. L.j. Moore Dds Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2407 W 104th St, Chicago, Illinois |
| Authorized Official Name and Position | Lee Joseph Moore (DENTIST/OWNER) |
| Authorized Official Contact | 7737798900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. L.j. Moore Dds Pc 2407 W 104th St Chicago IL 60655-1006 Ph: (773) 779-8900 | Dr. L.j. Moore Dds Pc 2407 W 104th St Chicago IL 60655-1006 Ph: (773) 779-8900 |
| NPI Number | 1043615669 |
|---|---|
| Provider Enumeration Date | 10/24/2014 |
| Last Update Date | 10/24/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043615669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019014938 (Illinois) | Primary |
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