Dr. Shannon Kenneth Moore is a Bloomington, Indiana based Dentist who is specialized in
Dentistry. He does not accept the Medicare-approved amount. Patients will be billed for the treatment. Active license number of Dr. Shannon Kenneth Moore is
12010311A for Dentistry in Indiana. His current practice location is
2815 N Walnut Street, Bloomington. Patients can reach him at
812-332-1405.
Dr. Shannon Kenneth Moore is the primary dental care provider for patients of all ages. He is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Profile:
Dr. Shannon Kenneth Moore speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
| Name: | Dr. Shannon Kenneth Moore |
| Specialization: | Dentist |
| Gender: | Male |
| Credentials: | DMD MSED |
| Accepts Medicare Assignment: | No |
| Practice Address: | 2815 N Walnut Street, Bloomington,
Indiana, 47404-2077 |
| Phone: | 812-332-1405 |
| Fax: | 812-332-4331 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
| NPI Number: | 1194855205 |
| NPI Enumeration Date: | 07 Mar, 2007 |
| NPI Last Update On: | 16 Mar, 2022 |
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Dr. Shannon Kenneth Moore are as mentioned below.
| License Number | Specialization | State | Status | |
| 12010311A | Dentistry | Indiana | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers associated with Dr. Shannon Kenneth Moore such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 200326230 | Medicaid | Indiana | |
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 2815 N Walnut Street,
Bloomington, Indiana |
| Zip: | 47404-2077 |
| Phone Number: | 812-332-1405 |
| Fax Number: | 812-332-4331 |
Patients can reach Dr. Shannon Kenneth Moore at
2815 N Walnut Street, Bloomington, Indiana or can
call to book an appointment on 812-332-1405.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.