MEDICARE: DR. JESSICA MOONEY DDS

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	122300000X	Dentist	13755	NC

General Provider Information

NPI Number	:	1285476820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA MOONEY DDS

Provider Business Mailing Address
First Line	:	1330 4TH STREET DR NW
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2524
Country	:	US
Telephone Number	:	828-322-6226
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 4TH STREET DR NW
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28601-2524
Country	:	US
Telephone Number	:	828-322-6226
Fax Number	:

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

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	06/12/2024

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