Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1114914066 Individual Practitioner Female Practitioner

Dr. Hazel E Moore , DDS

Dentist - General Practice • Kenosha, WI

Professional Overview & Biography Verified Profile Summary

Dr. Hazel Moore, DDS is a registered healthcare professional specializing in Dentist - General Practice in Kenosha, WI. Practice services are available at 4536 22ND AVE under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4536 22nd Ave

Kenosha, WI 531405917

Telephone 2626560044
Fax 2626532218
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Kenosha, WI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 24.5 Yrs
Regional Practice Density
56 Specialists

Practicing in Kenosha, WI (2459 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License WI 3267-015

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
33462500 (WI)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

40 Associated Practitioners
Dr. Cesar Gonzalez , DDS

Dentist - Pediatric Dentistry

NPI 1023005972

Doctor of Dental Surgery

Dr. Melissa Davis , DDS

Dentist - General Practice

NPI 1033649850

Doctor of Dental Surgery

Diane Kosar

Dental Hygienist

NPI 1043466196
NPI 1043657158

Doctor of Dental Surgery

Dr. Michael Mihajlovic , PsyD

Psychologist - Clinical

NPI 1124213954

Doctor of Psychology (Psy.D.)

Hannah Davidson , APSW

Social Worker - Clinical

NPI 1124773627

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active December 29, 2011

NPI status registered as active in NPPES database

📍
Updated Practice Location December 29, 2011

Registered at 4536 22ND AVE, KENOSHA, WI 531405917 (Tel: 2626560044)

📍
Updated Business Mailing Address December 29, 2011

Registered at 5822 CHARLES ST, RACINE, WI 534021824 (Tel: 2626812085)

👤
Provider Name / Credentials Updated December 29, 2011

Recorded as HAZEL MOORE, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 29, 2011

Dentist (License #3267-015 in WI)

🟢
Initial NPI Registration & Enumeration October 04, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1114914066
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: October 04, 2005
Last Update: December 29, 2011
Sole Proprietor: No

Mailing Address

5822 Charles St

Racine, WI 534021824

Phone: 2626812085

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.