Stacy J. Moon DDS, PA

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D3387 Issued in ID

Legal business name

STACY J. MOON DDS, PA

Practice address

6019 N Eagle Rd
Boise, ID 83713-0997

Phone

(208) 939-7053

Fax

(208) 938-6032

NPI assigned

Jul 9, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Stacy Jerald Moon, D.D.S.

Title

President

Phone

(208) 939-7053

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215561600000",
    "number": "1851554737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6019 N EAGLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130997",
            "telephone_number": "208-939-7053",
            "fax_number": "208-938-6032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6019 N EAGLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130997",
            "telephone_number": "208-939-7053",
            "fax_number": "208-938-6032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STACY J. MOON DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-09",
        "last_updated": "2008-07-09",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "JERALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-939-7053",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "ID",
            "license": "D3387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Lynn Stace, CSFA
• Stacey Titus PLLC
• Eric Gerand Stackle, MD
• Mary J Stackle, NP
• Daniel John Stackowicz, DDS
• Mardi Stacy, PH.D.
• Stephanie Elizabeth Stacy
• Heather Ann Stafford, NP-C
• Kayla Stafford
• Caitlin E Stagg, LMSW

• Dental Clinic/Center in Boise, ID
• Providers in Boise, ID by specialty
• Dental Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2008; 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.