Active NPI
Timothy Ryan Mooney, D.D.S.
- General Practice Dentistry
- Dallas, TX
National Provider Identifier
1710338702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 32894
- Practice address
- 2702 S Buckner Blvd Ste 110
Dallas, TX 75227-6903 - Phone
- (214) 886-3999
- NPI assigned
- Jun 30, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6680 | LA | |
| General Practice Dentistry | 1223G0001X | 32894 | TX | Primary |
Addresses
Primary practice location
2702 S Buckner Blvd Ste 110
Dallas, TX 75227-6903
Mailing address
401 38TH St
New Orleans, LA 70124-1523
Other practice location 1
4141 Bienville St # 105
New Orleans, LA 70119-5149
Phone (504) 900-1195
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 |
|---|---|---|---|
| 32894 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lake June SRGM PLLC | Current | Accepting new patients | |
| Broadmoor SRG PLLC | General Practice | Current | 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 and National Provider Directory roles.
-
- Dentist
- Dallas, TX
- NPI 1871187468
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467244800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613001600000",
"number": "1710338702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 38TH ST",
"city": "NEW ORLEANS",
"state": "LA",
"postal_code": "701241523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2702 S BUCKNER BLVD STE 110",
"city": "DALLAS",
"state": "TX",
"postal_code": "752276903",
"telephone_number": "214-886-3999"
}
],
"practiceLocations": [
{
"address_1": "4141 Bienville St # 105",
"address_purpose": "LOCATION",
"city": "New Orleans",
"state": "LA",
"postal_code": "701195149",
"country_code": "US",
"telephone_number": "504-900-1195",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOONEY",
"first_name": "TIMOTHY",
"middle_name": "RYAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-06-30",
"last_updated": "2021-02-11",
"certification_date": "2021-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "LA",
"license": "6680",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "32894",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.