Ethan Embrey Moore, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4212-21 Issued in MS

Practice address

430 Broad St
Columbia, MS 39429-3006

Phone

(601) 736-7125

NPI assigned

Jun 14, 2021

Last updated

Jul 7, 2025By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Moore Family Dental, PLLC

  dba Columbia Family Dental

  • General Practice Dentistry
  • Columbia, MS
  • NPI 1992695571
  NPD Authorized official

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

{
    "created_epoch": "1623628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1710555115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 BROAD ST",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394293006",
            "telephone_number": "601-736-7125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 BROAD ST",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394293006",
            "telephone_number": "601-736-7125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "ETHAN",
        "middle_name": "EMBREY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-14",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "4212-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mississippi Pharmaceutical Services, LLC (Columbia Medical Supply)
• Mississippi State Department of Health
• Jennifer Moak
• Lillian Grace Monroe
• Moore Family Dental, PLLC (Columbia Family Dental)
• Mariana Moreno
• Sabrina Luvenia Morgan
• Morning Star Transportation, LLC
• Motion Chiropractic LLC
• Laine A Murret, PT

• General Practice Dentistry in Columbia, MS
• Providers in Columbia, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; 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.