Ryan Thomas Moore, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

6075 Vantage PL
Rockford, IL 61107-5905

Phone

(815) 399-0677

Fax

(815) 399-9336

NPI assigned

Mar 16, 2007

Last updated

Jul 8, 2007By 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 IL

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

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.

• Thomas H. Moore D.D.S. LTD

  • General Practice Dentistry
  • Rockford, IL
  • NPI 1558814897
  Authorized official Same address or phone
• Thomas H. Moore DDS LTD

  • Dental Clinic/Center
  • Rockford, IL
  • NPI 1639202914
  Authorized official Same address or phone

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1588798813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6075 VANTAGE PL",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075905",
            "telephone_number": "815-399-0677",
            "fax_number": "815-399-9336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6075 VANTAGE PL",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075905",
            "telephone_number": "815-399-0677",
            "fax_number": "815-399-9336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "RYAN",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly James Moore, DDS
• Lily Moore, DPT
• Lindsay Danielle Moore, DMD
• Michelle Moore
• Nicole M Moore, APN
• S Christopher Moore, M.D.
• Tavares Moore
• Tom Harold Moore, D.D.S.
• Willard D. Moore, MD
• Elissa Morales-Villanueva, MAT, ATC

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• 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.