Healthcare Provider Details

I. General information

NPI: 1154249340
Provider Name (Legal Business Name): GREG MOORE, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

4723 N ROAN ST
JOHNSON CITY TN
37615-3976
US

IV. Provider business mailing address

4723 N ROAN ST
JOHNSON CITY TN
37615-3976
US

V. Phone/Fax

Practice location:
  • Phone: 423-283-0511
  • Fax: 423-283-0899
Mailing address:
  • Phone: 423-283-0511
  • Fax: 423-283-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MELVIN GREG MOORE
Title or Position: OWNER
Credential: DDS
Phone: 423-283-0511