Healthcare Provider Details

I. General information

NPI: 1164302592
Provider Name (Legal Business Name): CURTIS ALLEN MOORE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 W STROOP RD
DAYTON OH
45439-2041
US

IV. Provider business mailing address

945 LELAND AVE
DAYTON OH
45402-5311
US

V. Phone/Fax

Practice location:
  • Phone: 937-203-8115
  • Fax:
Mailing address:
  • Phone: 937-889-5453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: