Healthcare Provider Details

I. General information

NPI: 1801790225
Provider Name (Legal Business Name): MOORE PEDIATRIC DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MAGNOLIA CT STE. C
MOORE OK
73160-9999
US

IV. Provider business mailing address

537 NW 49TH ST
OKLAHOMA CITY OK
73118-6601
US

V. Phone/Fax

Practice location:
  • Phone: 405-973-8443
  • Fax:
Mailing address:
  • Phone: 405-973-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ALISON AGEE
Title or Position: OWNER
Credential: DDS
Phone: 405-973-8443