MEDICARE: DR. E. DREW MOORE DDS, MS

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	1223P0300X	Periodontics	16373	TX

General Provider Information

NPI Number	:	1336261551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. E. DREW MOORE DDS, MS

Provider Business Mailing Address
First Line	:	2820 VILLAGE PKWY STE 630
Second Line	:
City	:	HIGHLAND VLG
State	:	TX
Zip	:	75077-3299
Country	:	US
Telephone Number	:	972-966-2500
Fax Number	:	972-471-9833

Provider Business Practice Location Address
First Line	:	2820 VILLAGE PKWY STE 630
Second Line	:
City	:	HIGHLAND VLG
State	:	TX
Zip	:	75077-3299
Country	:	US
Telephone Number	:	972-966-2500
Fax Number	:	972-471-9833

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

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	01/23/2024

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