MEDICARE: BRYAN MOORE DDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	38407	TX

General Provider Information

NPI Number	:	1013408830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN MOORE DDS

Provider Business Mailing Address
First Line	:	2712 MATLOCK RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2588
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2712 MATLOCK RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76015-2588
Country	:	US
Telephone Number	:	817-468-5400
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/16/2024

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Directions to “ BRYAN MOORE DDS” Practice Location

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