Active NPI
Nicholas Anthony Moore, DDS
- Dentist
- Oviedo, FL
National Provider Identifier
1619381431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 20486
- Practice address
- 1013 Lockwood Blvd
Oviedo, FL 32765-6001 - Phone
- (407) 278-0934
- NPI assigned
- Jun 19, 2014
- Last updated
- Sep 1, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 | 20486 | FL | Primary |
Addresses
Primary practice location
1013 Lockwood Blvd
Oviedo, FL 32765-6001
Mailing address
1013 Lockwood Blvd
Oviedo, FL 32765-6001
Phone (407) 278-0934
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151001000426 | FL | Order and Referring Only - Oral Surgery | 5991013591 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20486 | FL | MD | Dentist |
Networks
- Freedom Health HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441065600000",
"number": "1619381431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1013 LOCKWOOD BLVD",
"city": "OVIEDO",
"state": "FL",
"postal_code": "327656001",
"telephone_number": "407-278-0934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1013 LOCKWOOD BLVD",
"city": "OVIEDO",
"state": "FL",
"postal_code": "327656001",
"telephone_number": "407-278-0934"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "NICHOLAS",
"middle_name": "ANTHONY",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-19",
"last_updated": "2015-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "20486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oviedo, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2015; 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.