Shannon Kenneth Moore in Bloomington - Dentist
Shannon Kenneth Moore - NPI 1194855205
Shannon Kenneth Moore is a Dentist in Bloomington, Indiana. Shannon Kenneth Moore practices all healthcare services and medical treatments related to Dentist. The NPI Number for Shannon Kenneth Moore is 1194855205. The last update date is 2022-03-16.
Shannon Kenneth Moore's current location address is 2815 N Walnut Street, Bloomington, Indiana. You can contact this provider via phone number 8123321405 and fax number 8123324331. The mailing address for Shannon Kenneth Moore is 2815 N Walnut Street, Bloomington, Indiana. To know further, please read the information below!
Provider Profile Detail
Provider Name | Shannon Kenneth Moore |
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Address | 2815 N Walnut Street, Bloomington, Indiana |
Phone Number | 8123321405 |
Fax Number | 8123324331 |
Sole Proprietor | N |
Credentials | DMD MSED |
NPI Number Detail
NPI Number | 1194855205 |
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Provider Enumeration Date | 2007-03-07 |
Last Updated Date | 2022-03-16 |
Provider Mailing Address Detail
Address | 2815 N Walnut Street |
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City | Bloomington |
State | Indiana (IN) |
Post Code | 474042077 |
Phone Number | 8123321405 |
Fax Number | 8123324331 |
Provider's Primary Taxonomy Detail
Speciality | Dentist |
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Taxonomy | 122300000X |
Licence No | 12010311A |
Definition: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: denti |
Provider's Other Legacy Identifiers
Identifier | Identifier Type | Identifier State | Identifier Issuer |
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200326230 | IN | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Shannon Kenneth Moore by the Centers for Medicare & Medicaid Services (CMS)?
The Shannon Kenneth Moore has been assigned the NPI (National Provider Identifier) 1194855205. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Can you provide the Shannon Kenneth Moore's physical address?
The Shannon Kenneth Moore is physically located at 2815 N Walnut Street, in the city of Bloomington, IN, with the postal code 474042077.
What is Shannon Kenneth Moore's specialized field of practice, and what is the corresponding taxonomy classification code?
The Shannon Kenneth Moore's area of specialization is Dentist, and the corresponding taxonomy code that categorizes this field of practice is 122300000X.
When did the Shannon Kenneth Moore receive its 1194855205?
The Shannon Kenneth Moore was issued its 1194855205 on 2007-03-07, which is the date when the organization was assigned this unique identifier.
When was the Shannon Kenneth Moore's information last updated?
The Shannon Kenneth Moore's information was last updated on 2022-03-16.