NPIMap

Individual provider Active NPI

Keith Edwin Moomaw, DDS

  • Dentist
  • Edgewood, MD
National Provider Identifier
1164645859
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
MD6960 Issued in MD
Practice address
1308 Business Center Way
Suite 105
Edgewood, MD 21040-1504
Phone
(410) 679-2790
NPI assigned
Apr 11, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X MD6960 MD Primary

Addresses

Primary practice location

1308 Business Center Way
Suite 105
Edgewood, MD 21040-1504

Mailing address

1308 Business Center Way
Suite 105
Edgewood, MD 21040-1504
Phone (410) 679-2790

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

LicenseStateTypeSpecialty
MD6960MDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Chesapeake Contemporary Dentistry, P.a. Dentist 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": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164645859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 BUSINESS CENTER WAY",
            "address_2": "SUITE 105",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "210401504",
            "telephone_number": "410-679-2790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 BUSINESS CENTER WAY",
            "address_2": "SUITE 105",
            "city": "EDGEWOOD",
            "state": "MD",
            "postal_code": "210401504",
            "telephone_number": "410-679-2790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOMAW",
        "first_name": "KEITH",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "MD6960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgewood, MD

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.

Verify at the official NPI Registry.