Active NPI
Michele Moreno, DDS
- General Practice Dentistry
- San Antonio, TX
National Provider Identifier
1902966922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 22779
- Practice address
- 11590 Galm Road
Suite 109
San Antonio, TX 78254 - Phone
- (210) 463-9339
- NPI assigned
- Dec 11, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 22779 | TX | Primary |
Addresses
Primary practice location
11590 Galm Road
Suite 109
San Antonio, TX 78254
Mailing address
11590 Galm Road
Suite 109
San Antonio, TX 78254
Phone (210) 463-9339
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E0147161 | Other | TX | DPS REGISTRATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22779 | TX | MD | Orientation and Mobility Training Rehabilitation Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alamo Springs Dental, PLLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- San Antonio, TX
- NPI 1912376880
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1902966922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11590 GALM ROAD",
"address_2": "SUITE 109",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78254",
"telephone_number": "210-463-9339"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11590 GALM ROAD",
"address_2": "SUITE 109",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "78254",
"telephone_number": "210-463-9339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MORENO",
"first_name": "MICHELE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "22779",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DPS REGISTRATION",
"identifier": "E0147161",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.