MEDICARE: JOHN W 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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DS017710L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598796278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN W MOONEY DDS

Provider Business Mailing Address
First Line	:	240 S 40TH ST
Second Line	:	SUITE 105
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-898-8991
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 S 40TH ST
Second Line	:	SUITE 105
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-6030
Country	:	US
Telephone Number	:	215-898-8991
Fax Number	:

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	01/11/2026

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Directions to “ JOHN W MOONEY DDS” Practice Location

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