Mark Phillip Moore, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

011706 Issued in GA

Practice address

2048 Windward LN
Gainesville, GA 30501-7418

Phone

(770) 297-7888

Fax

(770) 297-7833

NPI assigned

Sep 9, 2005

Sex

Male

Sole proprietor

No

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 Jun 18, 2015 through Jun 18, 2027

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.

• Mark Moore DMD, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Gainesville, GA
  • NPI 1336311414
  NPD (past) Authorized official

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

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1225022833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2048 WINDWARD LN",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017418",
            "telephone_number": "770-297-7888",
            "fax_number": "770-297-7833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2048 WINDWARD LN",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017418",
            "telephone_number": "770-297-7888",
            "fax_number": "770-297-7833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARK",
        "middle_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "GA",
            "license": "011706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Ann Moore, MD
• Denika L Moore, LD CPS FPM
• Derek Ronald Moore, MD
• Donna A Moore, APRN-C, PMHNP-BC, MS
• Frederick Stephen Moore, MD
• Sandy Townsend Moore, LPN
• Ana N Moreira, LCSW, NBCCH, MAC
• Jaime L Morel Ruiz, M.D.
• Elizabeth Perry Morgan, PA-C
• Heather M Morgan, AGACNP

• Oral and Maxillofacial Surgery (Dentist) in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Oral and Maxillofacial Surgery (Dentist) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.