Active NPI
Sunny Moon, DT
- Dental Therapist
- Bloomington, MN
National Provider Identifier
1487154092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Therapist
- License
- DT98
- Practice address
- 10584 France Ave S
Bloomington, MN 55431-3538 - Phone
- (952) 666-6000
- NPI assigned
- Feb 20, 2018
- Last updated
- Feb 13, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dental Therapist | 125J00000X | DT98 | MN | Primary |
Addresses
Primary practice location
10584 France Ave S
Bloomington, MN 55431-3538
Mailing address
636 Broadway St NE
Minneapolis, MN 55413-2164
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 |
|---|---|---|---|
| DT98 | MN | MD | Dental Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childrens Dental Services Inc | Past | Accepting new patients | |
| Children's Dental Services | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Public Health Dentistry
- Chisholm, MN
- NPI 1669842662
-
- Public Health Dentistry
- Minneapolis, MN
- NPI 1407973605
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581552000000",
"number": "1487154092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "636 BROADWAY ST NE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554132164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10584 FRANCE AVE S",
"city": "BLOOMINGTON",
"state": "MN",
"postal_code": "554313538",
"telephone_number": "952-666-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "SUNNY",
"credential": "DT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-20",
"last_updated": "2020-02-13",
"certification_date": "2020-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "125J00000X",
"taxonomy_group": "",
"desc": "Dental Therapist",
"state": "MN",
"license": "DT98",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.