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General NPI Number Information
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NPI Number | 1154558831
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Entity Type | Individual
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Provider Name | BEVERLY MOON DMD
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Gender | Female
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 5550 HEDGE LANE TER
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City | SHAWNEE
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State | KS
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Zip | 66226-2253
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Country | US
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Telephone | 913-422-6699
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 S GARFIELD ST
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City | JUNCTION CITY
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State | KS
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Zip | 66441-3966
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Country | US
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Telephone | 732-754-1998
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 60824
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License Number State | KS
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