Brent William Moore, DDS
Individual provider Active NPI General Practice Dentistry · Fairfield, TX
NPI 1104917178 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104917178
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 16589 (TX)
- Practice address
- 764 W Commerce St
Fairfield, TX 75840-1428 - Phone
- (903) 389-4151
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16589 | TX | MD | Chiropractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 16589 | TX | Yes |
Addresses
Primary practice location
764 W Commerce St
Fairfield, TX 75840-1428
Mailing address
764 W Commerce St
Fairfield, TX 75840-1428
Phone (903) 389-4151
Other providers in Fairfield, TX
- Ellen Elizabeth Mackey
- Mallorie Maggard
- Rosario Martinez-Badillo
- Medrec, Inc
- Kayla Yvonne Mitchell
- Christine Holt Moore
- John Daniel Morgan
- Moriah Munoz
- Matthew Noble
- Vance J Oglesbee
All providers in Fairfield, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.