MEDICARE: DR. PAIGE ANNE 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	122300000X	Dentist	319015727	IL
2	122300000X	Dentist	21883	TX

General Provider Information

NPI Number	:	1831147909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAIGE ANNE MOORE D.D.S

Provider Business Mailing Address
First Line	:	515 W BRIAR PL
Second Line	:	APT 302
City	:	CHICAGO
State	:	IL
Zip	:	60657-4658
Country	:	US
Telephone Number	:	512-350-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60603-6191
Country	:	US
Telephone Number	:	312-922-9595
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	01/23/2009

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