Kristen Ashraf Masoudipoya Moore, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN 21266 Issued in FL

Practice address

9109 Baymeadows Rd Ste 1
Jacksonville, FL 32256-1842

Phone

(904) 731-4343

Fax

(904) 733-0816

NPI assigned

Jun 30, 2015

Sex

Female

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 FL

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": "1435622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435622400000",
    "number": "1376926154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 6TH AVE S APT H",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322506664",
            "telephone_number": "904-614-0651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9109 BAYMEADOWS RD STE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322561842",
            "telephone_number": "904-731-4343",
            "fax_number": "904-733-0816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASOUDIPOYA MOORE",
        "first_name": "KRISTEN",
        "middle_name": "ASHRAF",
        "name_prefix": "Mrs.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-30",
        "last_updated": "2015-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 21266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; 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.