Gustavo Daniel Moretta, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12676 Issued in TN

Practice address

5606 Highway 153
Hixson, TN 37343-3725

Phone

(423) 877-1334

NPI assigned

Sep 25, 2023

Last updated

Jan 15, 2025By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Gustavo Moretta Dentistry, PLLC

  dba Big Ridge Family and Cosmetic Dentistry

  • Dental Clinic/Center
  • Hixson, TN
  • NPI 1104621820
  NPD Authorized official
• Big Ridge Family and Cosmetic Dentistry, PLLC

  • Dental Clinic/Center
  • Hixson, TN
  • NPI 1356676829
  NPD (past)

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

{
    "created_epoch": "1695600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736899200000",
    "number": "1598544025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5606 HIGHWAY 153",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373433725",
            "telephone_number": "423-877-1334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5606 HIGHWAY 153",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373433725",
            "telephone_number": "423-877-1334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORETTA",
        "first_name": "GUSTAVO",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-09-25",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "109092",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "12676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelley Mitchell, OTR/L
• Primesh Modi
• Leslie Noelle Corrao Montgomery
• Kristen Moody
• Aaron Lee Moore, ARNP
• Megan Dillon Morrisett
• Thomas Morrison
• Justin Morse, M.D.
• Vanessa Moser, FNP-C
• Charity A Moses, FNP

• General Practice Dentistry in Hixson, TN
• Providers in Hixson, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; 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.