MEDICARE: RICHARD E. MOORE, DDS, PC

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	1223E0200X	Endodontics	DS7145	TN

General Provider Information

NPI Number	:	1053539627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD E. MOORE, DDS, PC

Provider Business Mailing Address
First Line	:	11217 W POINT DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37934-2838
Country	:	US
Telephone Number	:	865-675-8877
Fax Number	:	865-675-0088

Provider Business Practice Location Address
First Line	:	11217 W POINT DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37934-2838
Country	:	US
Telephone Number	:	865-675-8877
Fax Number	:	865-675-0088

Authorized Official
Title or Position	:	PRESIDENT - OWNER
Name	:	DR. RICHARD ELLIOTT MOORE
Credential	:	D.D.S.
Telephone Number	:	865-675-8877

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	08/22/2020

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