Kelly J. Moore D.d.s., P.c.

NPI #1891897799 in Rockford, Illinois

Provider Information

NPI Number: 1891897799
Entity Type: Organization
Organization Name: Kelly J. Moore D.d.s., P.c.
Primary Specialty: Dentist - General Practice
Enumeration Date: Sep 1, 2006
Last Updated: Oct 10, 2008

Practice Location

Address: 6075 VANTAGE PL
City: Rockford
State: Illinois
ZIP Code: 61107-5905
Phone: (815) 399-9040

Authorized Official

Name: DR. KELLY JAMES MOORE, DDS
Title: DENTIST/OWNER
Phone: (815) 399-9040

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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