MEDICARE: JONAH R 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	1223G0001X	General Practice Dentistry	5197	LA

General Provider Information

NPI Number	:	1174683676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONAH R MOORE DDS

Provider Business Mailing Address
First Line	:	3430 MAGAZINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-2413
Country	:	US
Telephone Number	:	504-899-2333
Fax Number	:	504-897-6531

Provider Business Practice Location Address
First Line	:	3430 MAGAZINE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-2413
Country	:	US
Telephone Number	:	504-899-2333
Fax Number	:	504-897-6531

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	01/31/2022

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