Steven Michael Moore, D.D.S.
Individual provider Active NPI General Practice Dentistry · Fort Lupton, CO
NPI 1396840468 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1396840468
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- H105603 (CO)
- Practice address
- 230 Park Ave
Fort Lupton, CO 80621-1928 - Phone
- (303) 857-2258
- Fax
- (303) 857-9884
- NPI assigned
- Sep 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170315001668 | CO | Practitioner - Oral Surgery | 4688959570 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H105603 | CO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| HMJ PC | General Practice | Past | Accepting new patients |
| Center for Dental Sleep Medicine, Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | H105603 | CO | Yes |
Addresses
Primary practice location
230 Park Ave
Fort Lupton, CO 80621-1928
Mailing address
230 Park Ave
Fort Lupton, CO 80621-1928
Phone (303) 857-2258
Other providers in Fort Lupton, CO
- Benjamin A Martin
- Martin Daniel McDermott
- Hannah Meyer
- Stephanie N Miller
- Hadley Lyn Montoya
- Michael Moro
- North Range Behavioral Health
- North Range Behavioral Health
- North Range Behavioral Health
- Mariah O'Connell
All providers in Fort Lupton, CO · General Practice Dentistry in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.