Active NPI
Star Dental Canon City
- General Practice Dentistry
- Canon City, CO
National Provider Identifier
1912811910
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Legal business name
- STAR DENTAL CANON CITY
- Practice address
- 410 Macon Ave
Canon City, CO 81212-3225 - Phone
- (719) 276-0128
- NPI assigned
- Sep 29, 2026
- Last updated
- Sep 29, 2026
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gary Moore, DDS
- Title
- Owner Dentist
- Phone
- (719) 640-6407
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | NU | Primary | |
| Dental Clinic/Center | 261QD0000X | NU |
Addresses
Primary practice location
410 Macon Ave
Canon City, CO 81212-3225
Mailing address
410 Macon Ave
Canon City, CO 81212-3225
Phone (719) 276-0128
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790640000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1790640000000",
"number": "1912811910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "410 MACON AVE",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812123225",
"telephone_number": "719-276-0128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 MACON AVE",
"city": "CANON CITY",
"state": "CO",
"postal_code": "812123225",
"telephone_number": "719-276-0128"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STAR DENTAL CANON CITY",
"organizational_subpart": "NO",
"enumeration_date": "2026-09-29",
"last_updated": "2026-09-29",
"certification_date": "2026-09-29",
"status": "A",
"authorized_official_last_name": "MOORE",
"authorized_official_first_name": "GARY",
"authorized_official_title_or_position": "OWNER DENTIST",
"authorized_official_telephone_number": "719-640-6407",
"authorized_official_credential": "DDS"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canon City, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.