Marlon K Moore, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

045968 Issued in NY

Practice address

1776 Eastchester Rd Ste 230
Bronx, NY 10461-2335

Phone

(718) 518-1776

Fax

(718) 918-1776

NPI assigned

Aug 31, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710892800000",
    "number": "1467563262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 EASTCHESTER RD STE 230",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612335",
            "telephone_number": "718-518-1776",
            "fax_number": "718-918-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1776 EASTCHESTER RD STE 230",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612335",
            "telephone_number": "718-518-1776",
            "fax_number": "718-918-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "MARLON",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-03-20",
        "certification_date": "2024-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "045968",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01815892",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Jan Moore, M.D.
• Elain Moore
• Karen Joyce Moore, LMSW
• Kimora Moore, RN
• Lawanda Moore
• Meghan Kathleen Moore, RDN
• Michael T Moore, CASAC-T
• Mikyala Emoni-Iyana Moore
• Norman Moore, M.D.
• Queenasia Simone Moore, LMT

• Oral and Maxillofacial Surgery (Dentist) in Bronx, NY
• Providers in Bronx, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2024; 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.