Active NPI
Sandy Meade Moore III, DDS, MS
- Pediatric Dentistry
- Germantown, TN
National Provider Identifier
1275642357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DS 3561
- Practice address
- 1908 Exeter
Germantown, TN 38138-2971 - Phone
- (901) 683-3993
- Fax
- (901) 683-8283
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DS 3561 | TN | Primary |
Addresses
Primary practice location
1908 Exeter
Germantown, TN 38138-2971
Mailing address
1908 Exeter Rd
Germantown, TN 38138-2971
Phone (901) 683-3993
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS 3561 | TN | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273795200000",
"number": "1275642357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1908 EXETER RD",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381382971",
"telephone_number": "901-683-3993",
"fax_number": "901-683-8283"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1908 EXETER",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381382971",
"telephone_number": "901-683-3993",
"fax_number": "901-683-8283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "SANDY",
"middle_name": "MEADE",
"name_suffix": "III",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2010-05-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "TN",
"license": "DS 3561",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Germantown, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.