Active NPI
Jacob Gordon Moore, DDS
- General Practice Dentistry
- Waco, TX
National Provider Identifier
1124382957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 27978
- Practice address
- 10104 Saddle Creek Rd
Waco, TX 76708-7290 - Phone
- (254) 836-9595
- NPI assigned
- Jun 26, 2012
- Sex
- Male
- Sole proprietor
- No
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 | 27978 | TX | Primary |
Addresses
Primary practice location
10104 Saddle Creek Rd
Waco, TX 76708-7290
Mailing address
10104 Saddle Creek Rd
Waco, TX 76708-7290
Phone (254) 836-9595
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 |
|---|---|---|---|
| 27978 | TX | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saddle Creek Dental, PA | General Practice | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340668800000",
"number": "1124382957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10104 SADDLE CREEK RD",
"city": "WACO",
"state": "TX",
"postal_code": "767087290",
"telephone_number": "254-836-9595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10104 SADDLE CREEK RD",
"city": "WACO",
"state": "TX",
"postal_code": "767087290",
"telephone_number": "254-836-9595"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JACOB",
"middle_name": "GORDON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-26",
"last_updated": "2012-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "27978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.