MEDICARE: DR. CLARKE C. MOORE D.M.D.

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	2705	NV

General Provider Information

NPI Number	:	1891838850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARKE C. MOORE D.M.D.

Provider Business Mailing Address
First Line	:	9617 WINDOM POINT AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-7827
Country	:	US
Telephone Number	:	702-228-1625
Fax Number	:	702-260-1825

Provider Business Practice Location Address
First Line	:	9580 W SAHARA AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8807
Country	:	US
Telephone Number	:	702-242-4680
Fax Number	:	702-304-9996

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	01/04/2026

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