Active NPI
M Justin Moore, DMD MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Soldotna, AK
National Provider Identifier
1477664712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- AA618
- Practice address
- 112 N Binkley St
Soldotna, AK 99669 - Phone
- (907) 262-9425
- Fax
- (907) 262-6604
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | AA618 | AK | Primary |
Addresses
Primary practice location
112 N Binkley St
Soldotna, AK 99669
Mailing address
112 N Binkley St
Soldotna, AK 99669
Phone (907) 262-9425
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AK618 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AA618 | AK | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477664712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 N BINKLEY ST",
"city": "SOLDOTNA",
"state": "AK",
"postal_code": "99669",
"telephone_number": "907-262-9425",
"fax_number": "907-262-6604"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 N BINKLEY ST",
"city": "SOLDOTNA",
"state": "AK",
"postal_code": "99669",
"telephone_number": "907-262-9425",
"fax_number": "907-262-6604"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "M",
"middle_name": "JUSTIN",
"credential": "DMD MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "AK",
"license": "AA618",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "AK618",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Soldotna, AK
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.