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General NPI Number Information
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NPI Number | 1447691084
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Entity Type | Organization
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Legal Business Name | MOON FAMILY AND COSMETIC DENTAL, P.C.
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Dates
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Enumeration Date | 07/11/2013
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 960 BEAVER GRADE RD
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City | MOON TOWNSHIP
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State | PA
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Zip | 15108-2718
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Country | US
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Telephone | 412-262-3190
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Fax |
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Provider Business Mailing Address
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Address Line | 960 BEAVER GRADE RD
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City | MOON TOWNSHIP
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State | PA
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Zip | 15108-2718
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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 | PRESIDENT
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Name | DR. DAVID LUKE
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Credential | DDS
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Telephone | 412-262-3190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS039364
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License Number State | PA
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