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

Kellie Lynn Moore

Individual provider General Practice Dentistry · NPI 1942705140

Kellie Lynn Moore is a General Practice Dentistry in Chicago, Illinois. Licensed in Illinois. Registered with an NPI since 2018.

Licensed in
IL
In the registry since
2018
Specialties on file
3
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Practice location Address checks out

251 E Huron St
Chicago, IL 60611
Phone: (312) 926-2000
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Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 019031614 (IL)
General Practice Dentistry Taxonomy 1223G0001X · Licence 019031614 (IL)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1942705140
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 28, 2018
Last updated in NPPESJune 22, 2021
Certification dateJune 22, 2021
Mailing address251 E Huron St, Chicago, IL 60611-3055

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