Active NPI
Bradley Moon
- General Practice Dentistry
- Indianapolis, IN
National Provider Identifier
1326811167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1201-4426A
- Practice address
- 8602 E 10TH St
Indianapolis, IN 46219-5443 - Phone
- (309) 269-0390
- NPI assigned
- Nov 2, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1201-4426A | IN | Primary |
Addresses
Primary practice location
8602 E 10TH St
Indianapolis, IN 46219-5443
Mailing address
8602 E 10TH St
Indianapolis, IN 46219-5443
Phone (309) 269-0390
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1201-4426A | IN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1698883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1773792000000",
"number": "1326811167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8602 E 10TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462195443",
"telephone_number": "309-269-0390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8602 E 10TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462195443",
"telephone_number": "309-269-0390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "BRADLEY",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-11-02",
"last_updated": "2026-03-18",
"certification_date": "2026-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IN",
"license": "1201-4426A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.