Randolph S. Moore, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

011288 Issued in GA

Practice address

4470 Commerce Dr Ste B
Buford, GA 30518-7510

Phone

(770) 945-5369

Fax

(770) 945-1246

NPI assigned

Jan 11, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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 GA

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Randolph S Moore DMD PC

  • General Practice Dentistry
  • Buford, GA
  • NPI 1114470705
  NPD (past)

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

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528118429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4470 COMMERCE DR STE B",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305187510",
            "telephone_number": "770-945-5369",
            "fax_number": "770-945-1246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4470 COMMERCE DR STE B",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305187510",
            "telephone_number": "770-945-5369",
            "fax_number": "770-945-1246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RANDOLPH",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "011288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rima G Momin, PA-C
• Natalia Montalvo Ayala, M.S. CCC-SLP
• Jorge Montero, FNP
• Jayla Moon
• Michael Wayne Moore
• Sarah Moore
• Peggy Moppin
• Rene Bryant Morales Alarcon, DDS
• Christina Marie Moreno
• Kyle Richard Morey, AT, PT, DPT

• General Practice Dentistry in Buford, GA
• Providers in Buford, GA by specialty
• General Practice Dentistry in Georgia

• 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.