MEDICARE: MOORE FAMILY DENTISTRY

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	966	NV
2	122300000X	Dentist	3216	NV
3	122300000X	Dentist	3364	NV

General Provider Information

NPI Number	:	1538298534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORE FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	8409 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8409 W LAKE MEAD BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-7638
Country	:	US
Telephone Number	:	702-254-6700
Fax Number	:	702-254-9437

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID MOORE
Credential	:
Telephone Number	:	702-254-6700

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/22/2020

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1477681922 — DR. MICHAEL MARCUS MOORE DDS
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Directions to “MOORE FAMILY DENTISTRY ” Practice Location

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