Beverly Moon DMD LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BEVERLY MOON DMD LLC

Practice address

4601 W 109TH St Ste 240
Overland Park, KS 66211-1323

Phone

(913) 338-3384

NPI assigned

Mar 4, 2020

Organization subpart

No

Name

Beverly Moon, DMD

Title

Dentist

Phone

(732) 754-1998

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 4, 2020.

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1962037523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16424 LUCILLE ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662217032",
            "telephone_number": "732-754-1998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4601 W 109TH ST STE 240",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662111323",
            "telephone_number": "913-338-3384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY MOON DMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-04",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "MOON",
        "authorized_official_first_name": "BEVERLY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "732-754-1998",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 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.

Verify at the official NPI Registry.