Individual ProviderBlakely MooreDentistDental ProvidersPractice Address550 Chestnut St, Conway, AR 72032-5402(501) 329-8754(501) 658-9596PECOS EnrollmentBased on the most recent information from CMS, provider Blakely Moore does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 10:59 AM.Profile DetailsProvider ID1225923287Provider TypeIndividualFull NameMoore, BlakelyTitleDr.CredentialDDSGenderFemaleSole ProprietorNoEnumeration Date6/10/2025Last Updated6/10/2025Contact InformationPractice LocationPractice Address550 Chestnut St, Conway, AR 72032-5402Phone(501) 329-8754FaxUnlisted FaxMailing LocationMailing Address114 Magness Creek Dr, Cabot, AR 72023-8723Phone(501) 658-9596FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense4854Arkansas