MEDICARE: MRS. PAM CLEERE MOON 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	1223G0001X	General Practice Dentistry	13731	TX

General Provider Information

NPI Number	:	1619118874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. PAM CLEERE MOON DDS

Provider Business Mailing Address
First Line	:	7129 DOUGLAS LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76182-7702
Country	:	US
Telephone Number	:	817-905-6086
Fax Number	:

Provider Business Practice Location Address
First Line	:	7713 SAND ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76118
Country	:	US
Telephone Number	:	817-589-7374
Fax Number	:	817-589-9037

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

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	01/15/2017

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