Mark Andrew Moats, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6871 Issued in KY

Practice address

481 Klutey Park Plaza Dr
Henderson, KY 42420-3347

Phone

(270) 826-2677

Fax

(270) 826-8112

NPI assigned

Apr 30, 2007

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

Enrolled in KY

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": "1177891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1457571523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "481 KLUTEY PARK PLAZA DR",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424203347",
            "telephone_number": "270-826-2677",
            "fax_number": "270-826-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 KLUTEY PARK PLAZA DR",
            "city": "HENDERSON",
            "state": "KY",
            "postal_code": "424203347",
            "telephone_number": "270-826-2677",
            "fax_number": "270-826-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOATS",
        "first_name": "MARK",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "6871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey R Miller, MD
• Jason Roberts Millikan, LPCA
• James E Mingo, MS
• Christina Gail Mitchell, M.S.,CCC-SLP
• Mary Danielle Mitchell, R.D.
• Abdul Samee Mohammed, RPH
• Erin Lynn Monroe, R.N.
• Darrell Montgomery
• Sheri Dawn Montgomery, M.D.
• Stephanie D. Montgomery, LPCC

• General Practice Dentistry in Henderson, KY
• Providers in Henderson, KY by specialty
• General Practice Dentistry in Kentucky

• 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.
• 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.