Alecia A Moore, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3638-12 Issued in MS

Practice address

97 Hal Crocker Rd
Ellisville, MS 39437-2088

Phone

(601) 477-3779

NPI assigned

Jun 13, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective May 31, 2016 through May 31, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Group of Ellisville, PLLC

  • General Practice Dentistry
  • Ellisville, MS
  • NPI 1972851814

  General Practice

  NPD (past)

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

{
    "created_epoch": "1339545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435881600000",
    "number": "1114289394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 N VAN BUREN ST",
            "city": "CARTHAGE",
            "state": "MS",
            "postal_code": "390514160",
            "telephone_number": "601-267-3722",
            "fax_number": "601-267-0338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 HAL CROCKER RD",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394372088",
            "telephone_number": "601-477-3779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ALECIA",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-13",
        "last_updated": "2015-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3638-12",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lacey Leigh McLaurin, M.S. R.D.
• Clarence Lee Middleton, RPH
• Tony Earl Miller, N.P.
• Tracie Miller, CCSS
• Mississippi State Department of Health
• Joseph Rodney Moring, M.D.
• MW Staffing
• Fiso Ncube
• Edie Nicholson, PCMHT
• Nikki R Walters

• General Practice Dentistry in Ellisville, MS
• Providers in Ellisville, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2015; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.