NPIMap

Organization Active NPI

Ellis Moon Orthodontics, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Pearland, TX
National Provider Identifier
1720526593
Registry record updated Feb 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
15404 Issued in TX
Legal business name
ELLIS MOON ORTHODONTICS, PLLC
Practice address
2015 Broadway St
Suite a
Pearland, TX 77581-5698
Phone
(281) 485-6003
Fax
(281) 485-3376
NPI assigned
Feb 1, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2017

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

Authorized official

Name
Dr. Audrey Moon, D.D.S., M.S.D.NPI 1831591940
Title
Managing Member
Phone
(281) 485-6003

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 15404 TX Primary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223X0400X 28170 TX

Addresses

Primary practice location

2015 Broadway St
Suite a
Pearland, TX 77581-5698

Mailing address

2015 Broadway St
Suite a
Pearland, TX 77581-5698
Phone (281) 485-6003

National Provider Directory

National Provider Directory

Locations

2015 Broadway St
Ste A
Pearland, TX 77581
Phone (281) 485-6003

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1485907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485907200000",
    "number": "1720526593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 BROADWAY ST",
            "address_2": "SUITE A",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775815698",
            "telephone_number": "281-485-6003",
            "fax_number": "281-485-3376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 BROADWAY ST",
            "address_2": "SUITE A",
            "city": "PEARLAND",
            "state": "TX",
            "postal_code": "775815698",
            "telephone_number": "281-485-6003",
            "fax_number": "281-485-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS MOON ORTHODONTICS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-01",
        "last_updated": "2017-02-01",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "281-485-6003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S.,  M.S.D."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "15404",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "28170",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pearland, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; 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.