MEDICARE: DR. ANDREW G 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	36829	TX
2	390200000X	Student in an Organized Health Care Education/Training Program		TN
3	122300000X	Dentist	36829	TX

General Provider Information

NPI Number	:	1922621309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW G MOORE D.D.S

Provider Business Mailing Address
First Line	:	107 YALE ST STE 300
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3754
Country	:	US
Telephone Number	:	832-709-2418
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 YALE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3753
Country	:	US
Telephone Number	:	832-709-2418
Fax Number	:

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

Provider Enumeration Date	:	05/20/2020
Last Update Date	:	10/27/2021

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