Mobile Dent Inc PS

Primary specialty

DentistTaxonomy code 122300000X

License

5092 Issued in WA

Legal business name

MOBILE DENT INC PS

Practice address

13300 SE 30TH St Suite 101
Bellevue, WA 98005

Phone

(425) 747-5424

Fax

(425) 746-6332

NPI assigned

Mar 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Peter E Moore, DDS

Title

Dentist President

Phone

(425) 747-5424

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811026628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13300 SE 30TH ST SUITE 101",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98005",
            "telephone_number": "425-747-5424",
            "fax_number": "425-746-6332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13300 SE 30TH ST SUITE 101",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98005",
            "telephone_number": "425-747-5424",
            "fax_number": "425-746-6332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE DENT INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DENTIST PRESIDENT",
        "authorized_official_telephone_number": "425-747-5424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "5092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5531108",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.