Dr. L.J. Moore DDS PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019014938 Issued in IL

Legal business name

DR. L.J. MOORE DDS PC

Practice address

2407 W 104TH St
Chicago, IL 60655-1006

Phone

(773) 779-8900

Fax

(773) 779-2085

NPI assigned

Oct 24, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lee Joseph Moore, D.D.S

Title

Dentist/Owner

Phone

(773) 779-8900

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1414108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414108800000",
    "number": "1043615669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2407 W 104TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606551006",
            "telephone_number": "773-779-8900",
            "fax_number": "773-779-2085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 W 104TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606551006",
            "telephone_number": "773-779-8900",
            "fax_number": "773-779-2085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. L.J. MOORE DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-24",
        "last_updated": "2014-10-24",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "773-779-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019014938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Chicago, IL
• Providers in Chicago, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.