MEDICARE: BARBARA SEID MOON D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	13206	TX

General Provider Information

NPI Number	:	1598764854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA SEID MOON D.D.S

Provider Business Mailing Address
First Line	:	2009 JOHN ST
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77502-3375
Country	:	US
Telephone Number	:	713-473-6677
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 JOHN ST
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77502-3375
Country	:	US
Telephone Number	:	713-473-6677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	07/08/2007

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