Daisy Kit Moore, DDS PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

17839 Issued in TX

Practice address

1101 E State Highway 114
Suite 104
Southlake, TX 76092-5233

Phone

(817) 410-7373

Fax

(817) 416-9383

NPI assigned

Sep 16, 2005

Sex

Female

Sole proprietor

No

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 TX

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

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1397001600000",
    "number": "1437144292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 E STATE HIGHWAY 114",
            "address_2": "SUITE 104",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925233",
            "telephone_number": "817-410-7373",
            "fax_number": "817-416-9383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 E STATE HIGHWAY 114",
            "address_2": "SUITE 104",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925233",
            "telephone_number": "817-410-7373",
            "fax_number": "817-416-9383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DAISY",
        "middle_name": "KIT",
        "credential": "DDS PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-16",
        "last_updated": "2014-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "17839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Montague
• Tayler Montalvo
• Austin Montgomery
• Aika Moon
• Carrie Johnston Moore, LCSW
• Everrett Moore, PHD
• Julie Moore, PT
• Roberta Moore
• Halie Annette Moreno, PA-C, MPAS, MPH
• Nathaniel Moreno, RBT

• General Practice Dentistry in Southlake, TX
• Providers in Southlake, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2014; 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.