Active NPI
Kryste Avery-Moore
- Dentist
- Newark, NJ
National Provider Identifier
1588787782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 22DI101843100
- Practice address
- 110 William St
Room 111
Newark, NJ 07102-1304 - Phone
- (973) 733-7590
- NPI assigned
- Apr 10, 2007
- Last updated
- Mar 18, 2013
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 22DI101843100 | NJ | Primary |
Addresses
Primary practice location
110 William St
Room 111
Newark, NJ 07102-1304
Mailing address
110 William St
Room 111
Newark, NJ 07102-1304
Phone (973) 733-7590
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22DI101843100 | NJ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363564800000",
"number": "1588787782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 WILLIAM ST",
"address_2": "ROOM 111",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071021304",
"telephone_number": "973-733-7590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 WILLIAM ST",
"address_2": "ROOM 111",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071021304",
"telephone_number": "973-733-7590"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVERY-MOORE",
"first_name": "KRYSTE",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-10",
"last_updated": "2013-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NJ",
"license": "22DI101843100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.