Individual provider Active NPI

Alan Boyd Moore, DDS

  • General Practice Dentistry
  • Austin, TX
National Provider Identifier
1285743005
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11667 Issued in TX
Practice address
2911 Medical Arts Street #5
Austin, TX 78705-3302
Phone
(512) 478-7700
Fax
(512) 478-7715
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 11667 TX Primary

Addresses

Primary practice location

2911 Medical Arts Street #5
Austin, TX 78705-3302

Mailing address

2911 Medical Arts Street #5
Austin, TX 78705-3302
Phone (512) 478-7700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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

Enrollment IDStateProvider typePAC IDDetails
I20151009000474 TX Order and Referring Only - DentistPractitioner - Dentist 1456669506

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11667TXMDChiropractor

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1285743005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2911 MEDICAL ARTS STREET #5",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787053302",
            "telephone_number": "512-478-7700",
            "fax_number": "512-478-7715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2911 MEDICAL ARTS STREET #5",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787053302",
            "telephone_number": "512-478-7700",
            "fax_number": "512-478-7715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ALAN",
        "middle_name": "BOYD",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "11667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.