Active NPI
Ronald Moore
- General Practice Dentistry
- Prescott, AZ
National Provider Identifier
1922390822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D1717
- Practice address
- 222 S Summit Ave
Prescott, AZ 86303-3780 - Phone
- (928) 445-0582
- NPI assigned
- May 10, 2011
- Last updated
- May 10, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | D1717 | AZ | Primary |
Addresses
Primary practice location
222 S Summit Ave
Prescott, AZ 86303-3780
Mailing address
2430 N Shadow Valley Ranch TRL
Prescott, AZ 86305-6903
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D1717 | AZ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304985600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304985600000",
"number": "1922390822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2430 N SHADOW VALLEY RANCH TRL",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863056903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 S SUMMIT AVE",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863033780",
"telephone_number": "928-445-0582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "RONALD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-10",
"last_updated": "2011-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "D1717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.