David Dwight Moore Jr., D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

59684 Issued in CA

Practice address

235 N San Mateo Dr
Suite 400
San Mateo, CA 94401-2621

Phone

(650) 340-0225

NPI assigned

May 7, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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 Nov 10, 2015 through Nov 10, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283472000000",
    "number": "1225204407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 N SAN MATEO DR",
            "address_2": "SUITE 400",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012621",
            "telephone_number": "650-340-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 N SAN MATEO DR",
            "address_2": "SUITE 400",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012621",
            "telephone_number": "650-340-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DAVID",
        "middle_name": "DWIGHT",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-07",
        "last_updated": "2010-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "59684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RESIDENT PERMIT",
            "identifier": "R394",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melanie Cheryl Montoya
• Mitchell Montoya
• Cassie Moody
• Tom D Mooney III, D.C.
• Candy Jo Moore
• Diana Moore, MA LMFT LPCC
• Richard Jay Moore, M.D.
• Victoria E. Moore, D.D.S.
• Anissa Teresa Moorewilliams, CADC I
• Poornima Moorthy

• Endodontics in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Endodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2010; 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.