Active NPI
Michael Moon
- Dentist
- McAllen, TX
National Provider Identifier
1851761431
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 31458
- Practice address
- 1100 S Jackson Rd Ste 2&3
McAllen, TX 78503-1635 - Phone
- (956) 335-0553
- Fax
- (956) 335-5861
- NPI assigned
- Sep 25, 2015
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 31458 | TX | Primary |
Addresses
Primary practice location
1100 S Jackson Rd Ste 2&3
McAllen, TX 78503-1635
Mailing address
1100 S Jackson Rd Ste 2&3
McAllen, TX 78503-1635
Phone (956) 335-0553
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851761431 | Medicaid | TX |
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 |
|---|---|---|---|
| 31458 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1443139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578700800000",
"number": "1851761431",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 S JACKSON RD STE 2&3",
"city": "MCALLEN",
"state": "TX",
"postal_code": "785031635",
"telephone_number": "956-335-0553",
"fax_number": "956-335-5861"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 S JACKSON RD STE 2&3",
"city": "MCALLEN",
"state": "TX",
"postal_code": "785031635",
"telephone_number": "956-335-0553",
"fax_number": "956-335-5861"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-09-25",
"last_updated": "2020-01-11",
"certification_date": "2020-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "31458",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1851761431",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in McAllen, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.