Active NPI
Ernest Paul Moore, D.D.S.
- General Practice Dentistry
- New Melle, MO
National Provider Identifier
1003905910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13592
- Practice address
- 34 Muhm Center
New Melle, MO 63365-0218 - Phone
- (636) 828-4511
- Fax
- (636) 828-4599
- NPI assigned
- Oct 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13592 | MO | Primary |
Addresses
Primary practice location
34 Muhm Center
New Melle, MO 63365-0218
Mailing address
PO Box 218
New Melle, MO 63365-0218
Phone (636) 828-4511
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160419000366 | MO | Order and Referring Only - Dentist | 0749588119 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13592 | MO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694476800000",
"number": "1003905910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 218",
"city": "NEW MELLE",
"state": "MO",
"postal_code": "633650218",
"telephone_number": "636-828-4511",
"fax_number": "636-828-4599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 MUHM CENTER",
"city": "NEW MELLE",
"state": "MO",
"postal_code": "633650218",
"telephone_number": "636-828-4511",
"fax_number": "636-828-4599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "ERNEST",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-11",
"last_updated": "2023-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "13592",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Melle, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.