Moore Family Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MOORE FAMILY DENTAL, PLLC

Practice address

430 Broad St
Columbia, MS 39429-3006

Phone

(601) 736-7125

NPI assigned

Jul 7, 2025

Organization subpart

No

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

Authorized official

Name

Dr. Ethan Embrey Moore, DMDNPI 1710555115

Title

Dentist/Owner

Phone

(601) 736-7125

Specialties & licenses 1

Addresses

Other names 1

• Columbia Family Dental Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ethan Embrey Moore, DMD

  • General Practice Dentistry
  • Columbia, MS
  • NPI 1710555115
  NPD Authorized official
• Mai Lati

  • Dentist
  • Columbia, MS
  • NPI 1801505052
  NPD
• Michael David Fast, DDS

  • Dentist
  • Jackson, MS
  • NPI 1447304357
  NPD (past)

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

{
    "created_epoch": "1751846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1992695571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 BROAD ST",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394293006",
            "telephone_number": "601-736-7125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 BROAD ST",
            "city": "COLUMBIA",
            "state": "MS",
            "postal_code": "394293006",
            "telephone_number": "601-736-7125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOORE FAMILY DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-07-07",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "ETHAN",
        "authorized_official_middle_name": "EMBREY",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "601-736-7125",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbia Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janet Mingo
• Mississippi Pharmaceutical Services, LLC
• Mississippi State Department of Health
• Jennifer Moak
• Lillian Grace Monroe
• Ethan Embrey Moore, DMD
• Mariana Moreno
• Sabrina Luvenia Morgan
• Morning Star Transportation, LLC
• Motion Chiropractic LLC

• General Practice Dentistry in Columbia, MS
• Providers in Columbia, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; 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.