Tom Harold Moore, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

19A13410 Issued in IL

Practice address

6075 Vantage PL
Rockford, IL 61107-5905

Phone

(815) 399-0677

NPI assigned

Mar 14, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1366575722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4318 OWEN CENTER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611016108",
            "telephone_number": "815-963-8368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6075 VANTAGE PL",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075905",
            "telephone_number": "815-399-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "TOM",
        "middle_name": "HAROLD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "19A13410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Moore
• Nicole M Moore, APN
• Ryan Thomas Moore, DMD
• S Christopher Moore, M.D.
• Tavares Moore
• Willard D. Moore, MD
• Elissa Morales-Villanueva, MAT, ATC
• Pablo Morales, MD
• Richard J Moran, D.N.
• Linda A Morel, CCC-SLP/L

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.