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General NPI Number Information
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NPI Number | 1710907191
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Entity Type | Organization
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Legal Business Name | DENNIS R. MOONEY DDS, LLC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 215 OCHLOCKONEE ST
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City | CRAWFORDVILLE
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State | FL
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Zip | 32327-8022
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Country | US
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Telephone | 850-926-7151
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Fax | 850-926-6116
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Provider Business Mailing Address
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Address Line | 215 OCHLOCKONEE ST
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City | CRAWFORDVILLE
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State | FL
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Zip | 32327-8022
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Country | US
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Telephone | 850-926-7151
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Fax | 850-926-6116
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LEIGH E ANNAND
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Credential |
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Telephone | 850-926-7151
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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 | DN0006229
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License Number State | FL
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