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General NPI Number Information
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NPI Number | 1225695703
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Entity Type | Individual
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Provider Name | NICHOLAS JAY MOORE DDS
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Gender | Male
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Dates
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Enumeration Date | 05/21/2019
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 525 W 32ND STREET
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City | JOPLIN
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State | MO
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Zip | 64804
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Country | US
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Telephone | 417-781-5600
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Fax | 417-868-8263
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Provider Business Mailing Address
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Address Line | 401 HERITAGE ACRES DRIVE
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City | JOPLIN
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State | MO
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Zip | 64801
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Country | US
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Telephone | 816-699-0732
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2019016638
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License Number State | MO
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