Stacy Jerald Moon, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D3387 Issued in ID

Practice address

4266 N Eagle Rd
Boise, ID 83713-0726

Phone

(208) 939-7053

Fax

(208) 938-6032

NPI assigned

May 12, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

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

Practice roles

Locations

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.

• Zachary Taylor DDS PLLC

  • Dental Clinic/Center
  • Boise, ID
  • NPI 1467029736
  NPD

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688601600000",
    "number": "1881645166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3550 N BROOKSIDE LN",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837149705",
            "telephone_number": "208-908-1793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4266 N EAGLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130726",
            "telephone_number": "208-939-7053",
            "fax_number": "208-938-6032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOON",
        "first_name": "STACY",
        "middle_name": "JERALD",
        "name_prefix": "Mr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IRS",
            "identifier": "820527796",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stacey A Montoya, LMSW
• Nevaeh Liberty Monuteaux
• Ariel Claire Elizabeth Moon
• Bradley Moon, PHARMD
• Heather Kathleen Moon, LCSW
• Violet Leona Moon, CPM
• Carson A. Mooney, D.D.S.
• Darrel L Mooney, D.D.S. , F.A.C.P.
• Misha Dawn Mooney, L.AC, DIPL. O.M
• Pamela Ellen Mooney

• Dentist in Boise, ID
• Providers in Boise, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; 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.