Timothy Charles Moore, DDS,MSD

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

2901010163 Issued in MI

Practice address

826 Parchment Dr SE
Suite # 200
Grand Rapids, MI 49546-2374

Phone

(616) 285-9509

Fax

(616) 285-8856

NPI assigned

Jul 13, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679599930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "826 PARCHMENT DR SE",
            "address_2": "SUITE # 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462374",
            "telephone_number": "616-285-9509",
            "fax_number": "616-285-8856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "826 PARCHMENT DR SE",
            "address_2": "SUITE # 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462374",
            "telephone_number": "616-285-9509",
            "fax_number": "616-285-8856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "TIMOTHY",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DDS,MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-13",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MI",
            "license": "2901010163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara Jane Moore, AGACNP
• Shawn David Moore, MD
• Sidney Moore
• Spencer Edmund Moore
• Taylor L Moore
• William David Moore, M.D.
• Shelby Moorman
• Tylar Moorman, BT
• Mackenzie Sue Moquin, MD
• Danielle Therese Mora, CRNA

• Prosthodontics in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Prosthodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.