Fredric A Moore, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

DN010414 Issued in GA

Practice address

514 W Bankhead Hwy Ste 600
Villa Rica, GA 30180-1739

Phone

(770) 456-2550

NPI assigned

Jan 23, 2015

Last updated

Jan 23, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fredric a Moore DMD PC

  • Endodontics
  • Villa Rica, GA
  • NPI 1366652174
  NPD (past) Authorized official
• Brian a Bain DDS III PC

  • General Practice Dentistry
  • Villa Rica, GA
  • NPI 1972967024
  NPD (past)

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

{
    "created_epoch": "1421971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421971200000",
    "number": "1346630712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 W BANKHEAD HWY STE 600",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801739",
            "telephone_number": "770-456-2550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 W BANKHEAD HWY STE 600",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801739",
            "telephone_number": "770-456-2550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "FREDRIC",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-01-23",
        "last_updated": "2015-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN010414",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR FREDRIC A MOORE, DMD, PC (ORGANIZATION)",
            "identifier": "1366652174",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mirror Lake Drugs & Medical Services LLC (Mirror Lake Drugs)
• Mirror Lake Drugs & Medical Services LLC
• Mobolaji Shalom Oyebanjo, Inc (The Potter Behavioral Medicine Clinic)
• Allyson Moffatt, LPC
• Danielle Monroe
• Eric L Morante, PT
• Arcelica Knittyada Moreland
• Carlos Julio Moreno
• Alishia Morgan, LPN
• Tyler Morris, PTA

• Dentist in Villa Rica, GA
• Providers in Villa Rica, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.