MEDICARE: DR. ERNEST PAUL MOORE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13592	MO

General Provider Information

NPI Number	:	1003905910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST PAUL MOORE D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 218
Second Line	:
City	:	NEW MELLE
State	:	MO
Zip	:	63365-0218
Country	:	US
Telephone Number	:	636-828-4511
Fax Number	:	636-828-4599

Provider Business Practice Location Address
First Line	:	34 MUHM CENTER
Second Line	:
City	:	NEW MELLE
State	:	MO
Zip	:	63365-0218
Country	:	US
Telephone Number	:	636-828-4511
Fax Number	:	636-828-4599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	09/12/2023

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