Michael Moon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7615 Issued in OK

Practice address

2611 W Broadway Ave
Sulphur, OK 73086-6518

Phone

(580) 622-6655

NPI assigned

Jun 30, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sulphur Dentistry & Braces

  • Dental Clinic/Center
  • Sulphur, OK
  • NPI 1730679606
  NPD

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

{
    "created_epoch": "1656547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1336871995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 CLOVERLEAF PL",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734013421",
            "telephone_number": "214-713-9759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2611 W BROADWAY AVE",
            "city": "SULPHUR",
            "state": "OK",
            "postal_code": "730866518",
            "telephone_number": "580-622-6655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-30",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "7615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Website",
            "affiliation": "N",
            "endpointDescription": "https://sulphurdentistry.com/",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2611 W Broadway Ave",
            "city": "Sulphur",
            "state": "OK",
            "country_code": "US",
            "postal_code": "730866518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kayla Michelle McClure
• Kenneth McCracken
• Sheri Medcalf
• Mental Health Services of Southern Oklahoma
• Metro Clinics
• Mickey Morrow, DPH
• Murray County E.M.S.
• Murray DME
• Susan Murray, DPH
• Native Wellness LLC

• General Practice Dentistry in Sulphur, OK
• Providers in Sulphur, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; 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.