MEDICARE: MICHAEL TAYLOR MOORE D.D.S.

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	1223G0001X	General Practice Dentistry	D14671	TX

General Provider Information

NPI Number	:	1346375987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL TAYLOR MOORE D.D.S.

Provider Business Mailing Address
First Line	:	4913 RUFE SNOW DR
Second Line	:	SUITE 104
City	:	FORT WORTH
State	:	TX
Zip	:	76180-7856
Country	:	US
Telephone Number	:	817-656-2945
Fax Number	:

Provider Business Practice Location Address
First Line	:	4913 RUFE SNOW DR
Second Line	:	SUITE 104
City	:	FORT WORTH
State	:	TX
Zip	:	76180-7856
Country	:	US
Telephone Number	:	817-656-2945
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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