MEDICARE: DR. JAMES G 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	8315	TX

General Provider Information

NPI Number	:	1861699381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES G MOORE DDS

Provider Business Mailing Address
First Line	:	1121 UPTOWN PARK BLVD STE 19
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-3226
Country	:	US
Telephone Number	:	713-621-4830
Fax Number	:	713-621-6261

Provider Business Practice Location Address
First Line	:	1121 UPTOWN PARK BLVD STE 19
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77056-3226
Country	:	US
Telephone Number	:	713-621-4830
Fax Number	:	713-621-6261

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

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	07/08/2007

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