| Stacy J. Moon Dds, Pa | |
|
6019 N Eagle Rd Boise ID 83713-0997 | |
| (208) 939-7053 | |
| (208) 938-6032 |
| Full Name | Stacy J. Moon Dds, Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 6019 N Eagle Rd, Boise, Idaho |
| Authorized Official Name and Position | Stacy Jerald Moon (PRESIDENT) |
| Authorized Official Contact | 2089397053 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Stacy J. Moon Dds, Pa 6019 N Eagle Rd Boise ID 83713-0997 Ph: (208) 939-7053 | Stacy J. Moon Dds, Pa 6019 N Eagle Rd Boise ID 83713-0997 Ph: (208) 939-7053 |
| NPI Number | 1851554737 |
|---|---|
| Provider Enumeration Date | 07/09/2008 |
| Last Update Date | 07/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851554737 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | D3387 (Idaho) | Primary |
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