Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Shannon Kenneth Moore, DMDMSED

Individual provider Dentist · NPI 1194855205

Dr. Shannon Kenneth Moore, DMDMSED is a Dentist in Bloomington, Indiana. Licensed in Indiana. Registered with an NPI since 2007.

Licensed in
IN
In the registry since
2007

Practice location Address checks out

2815 N Walnut St
Bloomington, IN 47404-2077
Phone: (812) 332-1405
Fax: (812) 332-4331
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 12010311A (IN)

Record details

NPI number1194855205
Entity typeIndividual (Type 1)
GenderMale
Credentials DMDMSED
Sole proprietorNo
NPI enumeratedMarch 7, 2007
Last updated in NPPESMarch 16, 2022
Certification dateMarch 16, 2022

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