Kelly J. Moore D.D.S., P.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

060-003341 Issued in IL

Legal business name

KELLY J. MOORE D.D.S., P.C.

Practice address

6075 Vantage PL
Rockford, IL 61107-5905

Phone

(815) 399-9040

Fax

(815) 399-9336

NPI assigned

Sep 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kelly James Moore, DDS

Title

Dentist/Owner

Phone

(815) 399-9040

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223596800000",
    "number": "1891897799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6075 VANTAGE PL",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075905",
            "telephone_number": "815-399-9040",
            "fax_number": "815-399-9336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6075 VANTAGE PL",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611075905",
            "telephone_number": "815-399-9040",
            "fax_number": "815-399-9336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KELLY J. MOORE D.D.S., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2008-10-10",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "815-399-9040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "060-003341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michaela Lee Keister, DPT
• John J Keith, MD
• Mary E Keller, M.D.
• Cynthia Kelling, APN
• Kelly a. Kalt, MSW, LCSW, Inc.
• Jennifer Kay Kelly, PHARM D
• Kathleen M Kelly
• Karen A. Kelman-Weber, OTR/L, CHT
• Francois M. Kelso, P.A.-C.
• Stephen Kemnele

• General Practice Dentistry in Rockford, IL
• Providers in Rockford, IL by specialty
• General Practice Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; 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.