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General NPI Number Information
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NPI Number | 1154249340
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Entity Type | Organization
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Legal Business Name | GREG MOORE, DDS
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Dates
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Enumeration Date | 07/07/2026
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Last Update Date | 07/07/2026
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Provider Practice Location Address
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Address Line | 4723 N ROAN ST
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City | JOHNSON CITY
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State | TN
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Zip | 37615-3976
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Country | US
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Telephone | 423-283-0511
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Fax | 423-283-0899
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Provider Business Mailing Address
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Address Line | 4723 N ROAN ST
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City | JOHNSON CITY
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State | TN
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Zip | 37615-3976
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Country | US
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Telephone | 423-283-0511
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Fax | 423-283-0899
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELVIN GREG MOORE
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Credential | DDS
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Telephone | 423-283-0511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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