Active NPI
Regan L Moore, DDS
- Periodontics
- Louisville, KY
National Provider Identifier
1093853095
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 5947
- Practice address
- 501 S Preston St
Louisville, KY 40292-0001 - Phone
- (502) 852-5128
- Fax
- (502) 852-7163
- NPI assigned
- Feb 2, 2007
- 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 |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 5947 | KY | Primary |
Addresses
Primary practice location
501 S Preston St
Louisville, KY 40292-0001
Mailing address
501 S Preston St
Louisville, KY 40292-0001
Phone (502) 852-5128
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9179124 | Other | DORAL DENTAL | |
| 6003670 | Medicaid | KY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5947 | KY | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170374400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093853095",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 S PRESTON ST",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402920001",
"telephone_number": "502-852-5128",
"fax_number": "502-852-7163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "501 S PRESTON ST",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402920001",
"telephone_number": "502-852-5128",
"fax_number": "502-852-7163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "REGAN",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "KY",
"license": "5947",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL DENTAL",
"identifier": "9179124",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6003670",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.