=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760376990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEGHAN N MOORE DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2025
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21800 PONTIAC TRL STE 100
-----------------------------------------------------
City | SOUTH LYON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48178-7400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-437-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21800 PONTIAC TRL STE 100
-----------------------------------------------------
City | SOUTH LYON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48178-7400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-437-8300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. MEGHAN MOORE
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 248-872-6619
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------