Michael Moon

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN123174 Issued in GA

Practice address

1595 Peachtree Pkwy Ste 207
Cumming, GA 30041-9583

Phone

(177) 088-8828

NPI assigned

Jul 21, 2023

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1093495244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9771 TALISMAN DR",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300227163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1595 PEACHTREE PKWY STE 207",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300419583",
            "telephone_number": "177-088-8828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-21",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN123174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lydia Azeala Monk, DDS
• Shelly Elaine Montes, D.D.S
• Gerald E. Moody, MD
• Kara Keel Moody, D.M.D.
• Jennifer Staller Moon, LPC
• Carolyn Meredith Moore, NP-C
• David K. Moore, M.D.
• Marissa Moore, PT, DPT
• Maycee Moore
• Sierra Beth Moore

• General Practice Dentistry in Cumming, GA
• Providers in Cumming, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.