Paul Randall Moon, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

25070 Issued in CA

Practice address

2060 Main St
Red Bluff, CA 96080-2373

Phone

(530) 527-2147

Fax

(530) 527-2410

NPI assigned

Oct 13, 2006

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205193600000",
    "number": "1508956012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2060 MAIN ST",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960802373",
            "telephone_number": "530-527-2147",
            "fax_number": "530-527-2410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 MAIN ST",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960802373",
            "telephone_number": "530-527-2147",
            "fax_number": "530-527-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "PAUL",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2008-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "25070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi C Mist, MD, MPH&TM
• Sally Mitchell-Cox, CNM
• Seth Moerkerke
• James Vincent Montana
• Teresa (Tea) Jane Montgomery
• Lorenzo Moore
• William Jeffrey Moore, D.M.D.
• Bradlee Ruth Moose
• Marlin Mora-Patricio
• Evelyn Lynette Mora-Tello

• General Practice Dentistry in Red Bluff, CA
• Providers in Red Bluff, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.