Evan Stout Moore, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11410 Issued in NC

Practice address

201 N Dalton St
Madison, NC 27025-1903

Phone

(336) 548-9678

NPI assigned

May 31, 2019

Last updated

Sep 18, 2024By the provider in NPPES

Sex

Male

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 NC

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.

• Londry& Modlin V DDS PLLC

  dba Madison Dental

  • General Practice Dentistry
  • Madison, NC
  • NPI 1275199234
  NPD (past)
• William H. Lewis, Jr. DDS PA

  • Dental Clinic/Center
  • Madison, NC
  • NPI 1538331004
  NPD (past)

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

{
    "created_epoch": "1559260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726617600000",
    "number": "1548828916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19810 W CATAWBA AVE STE A1",
            "city": "CORNELIUS",
            "state": "NC",
            "postal_code": "280314056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N DALTON ST",
            "city": "MADISON",
            "state": "NC",
            "postal_code": "270251903",
            "telephone_number": "336-548-9678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "EVAN",
        "middle_name": "STOUT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-31",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "11410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Pharmacy and Homecare
• Madison Pharmacy and Homecare, Inc
• Mary Margaret Martin, FNP
• Schubert Dean McPhail, MD
• Donald Wilson Moore, MD
• Meritza Moorefield, RPH
• Tiffany Milan Morgan, NP
• Moses Cone Medical Services, Inc. (Western Rockingham Family Medicine)
• Diletta Mouzon
• Myeyedr Optometry of North Carolina PLLC (MyEyeDr)

• General Practice Dentistry in Madison, NC
• Providers in Madison, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; 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.