| Ellis Moon Orthodontics, Pllc | |
|
2015 Broadway St Suite A Pearland TX 77581-5698 | |
| (281) 485-6003 | |
| (281) 485-3376 |
| Full Name | Ellis Moon Orthodontics, Pllc |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 2015 Broadway St, Pearland, Texas |
| Authorized Official Name and Position | Audrey Moon (MANAGING MEMBER) |
| Authorized Official Contact | 2814856003 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellis Moon Orthodontics, Pllc 2015 Broadway St Suite A Pearland TX 77581-5698 Ph: (281) 485-6003 | Ellis Moon Orthodontics, Pllc 2015 Broadway St Suite A Pearland TX 77581-5698 Ph: (281) 485-6003 |
| NPI Number | 1720526593 |
|---|---|
| Provider Enumeration Date | 02/01/2017 |
| Last Update Date | 02/01/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720526593 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 15404 (Texas) | Primary |
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 28170 (Texas) | Secondary |
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