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General NPI Number Information
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NPI Number | 1013658681
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Entity Type | Organization
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Legal Business Name | DR. KERRY MOON, D.D.S., PLLC
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 2501 CRESTWOOD RD STE 201
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72116-7616
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Country | US
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Telephone | 501-758-5006
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Fax |
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Provider Business Mailing Address
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Address Line | 719 WILLOW ST
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72114-4637
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. KERY MOON
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Credential | DDS
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Telephone | 501-281-5347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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