Carol Lynn Moreno, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6899 Issued in IA

Practice address

1205 N Columbus St
West Liberty, IA 52776-9601

Phone

(319) 627-2612

Fax

(319) 627-2178

NPI assigned

Aug 31, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

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.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Gentle Family Dentists

  • Dental Clinic/Center
  • West Liberty, IA
  • NPI 1932376191
  NPD (past) Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347321600000",
    "number": "1174635221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1205 N COLUMBUS ST",
            "city": "WEST LIBERTY",
            "state": "IA",
            "postal_code": "527769601",
            "telephone_number": "319-627-2612",
            "fax_number": "319-627-2178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 N COLUMBUS ST",
            "city": "WEST LIBERTY",
            "state": "IA",
            "postal_code": "527769601",
            "telephone_number": "319-627-2612",
            "fax_number": "319-627-2178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "CAROL",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2012-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "6899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1216853",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lauren E Hanna, MD
• Hy-Vee Inc
• Yurico Johana Maldonado
• MCLD Corporation
• Mercy Services Iowa City, Inc.
• Roberto Alexis Moreno, D.D.S.
• Dana Lynn Nelson, D.C.
• Sarah Schoon, LAT, ATC
• David R Sheff, MD, PHD
• Douglas Siemen, PTA

• General Practice Dentistry in West Liberty, IA
• Providers in West Liberty, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.