NPIMap

Organization Active NPI

Fredric a Moore DMD PC

  • Endodontics
  • Villa Rica, GA
National Provider Identifier
1366652174
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
10414 Issued in GA
Legal business name
FREDRIC A MOORE DMD PC
Practice address
514 W Bankhead Hwy
Suite 600
Villa Rica, GA 30180-1736
Phone
(770) 456-2550
Fax
(770) 456-7680
NPI assigned
May 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Authorized official

Name
Dr. Fredric A Moore, DMDNPI 1346630712
Title
President
Phone
(770) 456-2550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X 10414 GA Primary

Addresses

Primary practice location

514 W Bankhead Hwy
Suite 600
Villa Rica, GA 30180-1736

Mailing address

514 W Bankhead Hwy
Suite 600
Villa Rica, GA 30180-1736
Phone (770) 456-2550

National Provider Directory

National Provider Directory

Locations

514 W Bankhead Hwy
Ste 600
Villa Rica, GA 30180
Phone (770) 456-2550

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1366652174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 W BANKHEAD HWY",
            "address_2": "SUITE 600",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801736",
            "telephone_number": "770-456-2550",
            "fax_number": "770-456-7680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 W BANKHEAD HWY",
            "address_2": "SUITE 600",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301801736",
            "telephone_number": "770-456-2550",
            "fax_number": "770-456-7680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDRIC A MOORE DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2015-01-23",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "FREDRIC",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-456-2550",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "10414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Villa Rica, GA

Sources for this page

  • 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.