MEDICARE: WHITNEY MONET MOORE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12010224A	IN
2	1223G0001X	General Practice Dentistry	30-022597	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013987114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY MONET MOORE DDS

Provider Business Mailing Address
First Line	:	3232 E FALL CREEK PARKWAY NORTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3858
Country	:	US
Telephone Number	:	317-513-8669
Fax Number	:

Provider Business Practice Location Address
First Line	:	3232 E FALL CREEK PARKWAY NORTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-3858
Country	:	US
Telephone Number	:	317-513-8669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	11/18/2020

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