MEDICARE: STEVEN BARRETT MOORE II DMD

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	122300000X	Dentist	11113	KY

General Provider Information

NPI Number	:	1063264075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN BARRETT MOORE II DMD

Provider Business Mailing Address
First Line	:	5613 N WOLF CRK
Second Line	:
City	:	LOVELY
State	:	KY
Zip	:	41231-8964
Country	:	US
Telephone Number	:	606-471-5454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1983 DIXIE HWY
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41011-2607
Country	:	US
Telephone Number	:	859-415-4800
Fax Number	:

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

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	07/03/2024

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