MEDICARE: ANN 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	18776	TX

General Provider Information

NPI Number	:	1043515695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN MOORE, DDS

Provider Business Mailing Address
First Line	:	15068 SAN PEDRO
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3714
Country	:	US
Telephone Number	:	210-494-7681
Fax Number	:	210-494-7682

Provider Business Practice Location Address
First Line	:	15068 SAN PEDRO
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-3714
Country	:	US
Telephone Number	:	210-494-7681
Fax Number	:	210-494-7682

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANN MOORE
Credential	:	DDS
Telephone Number	:	210-494-7681

Provider Enumeration Date	:	01/12/2011
Last Update Date	:	01/12/2011

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