MEDICARE: JOSEPH MOON DMD

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	1223P0221X	Pediatric Dentistry	41935	TX

General Provider Information

NPI Number	:	1821725821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH MOON DMD

Provider Business Mailing Address
First Line	:	19035 TALAVERA RDG APT 1101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1382
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17026 BULVERDE RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-4700
Country	:	US
Telephone Number	:	210-972-6356
Fax Number	:

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

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	09/15/2025

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Directions to “ JOSEPH MOON DMD” Practice Location

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