Meghan Moore, DDS
Individual provider Active NPI Dentist · Coopersville, MI
NPI 1609435676 · NPPES record last updated Jun 12, 2019
Key facts
- NPI
- 1609435676
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 2901600116 (MI)
- Practice address
- 502 W Randall St
Coopersville, MI 49404-1341 - Phone
- (616) 384-4129
- NPI assigned
- Jun 12, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2901600116 | MI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 2901600116 | MI | Yes |
Addresses
Primary practice location
502 W Randall St
Coopersville, MI 49404-1341
Mailing address
402 College Ave SE Unit 2
Grand Rapids, MI 49503-5302
Phone (248) 872-6619
Other providers in Coopersville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.