Kevin Brent Moore, DMD
Individual provider Active NPI Dentist · Garrett, KY
NPI 1225199706 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1225199706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 7061 (KY)
- Practice address
- 95 Stonecoal Road
Garrett, KY 41630 - Phone
- (606) 358-9135
- Fax
- (606) 358-0005
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7061 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7061 | KY | Yes |
Addresses
Primary practice location
95 Stonecoal Road
Garrett, KY 41630
Mailing address
PO Box 427
Garrett, KY 41630
Phone (606) 358-9135
Other providers in Garrett, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.