Kevin Lee Moore, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS-022522-L Issued in PA

Practice address

160 S 2ND Ave
Suite B
Clarion, PA 16214-2444

Phone

(814) 226-6321

Fax

(814) 226-6353

NPI assigned

Jan 1, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in PA

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

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

{
    "created_epoch": "1167609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275690323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 S 2ND AVE",
            "address_2": "SUITE B",
            "city": "CLARION",
            "state": "PA",
            "postal_code": "162142444",
            "telephone_number": "814-226-6321",
            "fax_number": "814-226-6353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 S 2ND AVE",
            "address_2": "SUITE B",
            "city": "CLARION",
            "state": "PA",
            "postal_code": "162142444",
            "telephone_number": "814-226-6321",
            "fax_number": "814-226-6353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "KEVIN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS-022522-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas James Miller, DPM
• Erin Rae Minich, DO.
• Jane M Minich, BA
• Erin D Monrean, BA
• Ann C Montgomery, BS
• Thomas J Morgo, CRNA
• Kristy Marie Murphy, NBC-HWC, CPT
• John H Myers, D.O.
• Nelson R. Whitling, OD Co
• Mary Jayne Nick, CRNP

• General Practice Dentistry in Clarion, PA
• Providers in Clarion, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.