Dod David Moore, D.D.S.
Individual provider Active NPI Dentist · Waco, TX
NPI 1952429367 · NPPES record last updated Mar 26, 2013
Key facts
- NPI
- 1952429367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 22305 (TX)
- Practice address
- 10104 Saddle Creek Rd
Waco, TX 76708 - Phone
- (254) 836-9595
- NPI assigned
- Mar 26, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22305 | TX | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saddle Creek Dental, PA | Past | Accepting new patients | |
| Cross Creek Dental | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 22305 | TX | Yes |
Addresses
Primary practice location
10104 Saddle Creek Rd
Waco, TX 76708
Mailing address
10104 Saddle Creek Rd
Waco, TX 76708-7290
Phone (254) 836-9595
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G60270-01 | Other | TX | DELTA DENTAL CHIPS |
Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.