Brenden Delaney Moon in Carthage - Dentist
Brenden Delaney Moon - NPI 1730375171
Brenden Delaney Moon is a Dentist in Carthage, Illinois. Brenden Delaney Moon practices all healthcare services and medical treatments related to Dentist. The NPI Number for Brenden Delaney Moon is 1730375171. The last update date is 2011-09-07.
Brenden Delaney Moon's current location address is 671 Wabash Ave, Carthage, Illinois. You can contact this provider via phone number 2173572171 and fax number 2173573562. The mailing address for Brenden Delaney Moon is 671 Wabash Ave, Carthage, Illinois. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Brenden Delaney Moon |
|---|---|
| Address | 671 Wabash Ave, Carthage, Illinois |
| Phone Number | 2173572171 |
| Fax Number | 2173573562 |
| Sole Proprietor | N |
| Credentials | DMD |
NPI Number Detail
| NPI Number | 1730375171 |
|---|---|
| Provider Enumeration Date | 2007-09-19 |
| Last Updated Date | 2011-09-07 |
Provider Mailing Address Detail
| Address | 671 Wabash Ave |
|---|---|
| City | Carthage |
| State | Illinois (IL) |
| Post Code | 62321 |
| Phone Number | 2173572171 |
| Fax Number | 2173573562 |
Provider's Primary Taxonomy Detail
| Speciality | Dentist |
|---|---|
| Taxonomy | 122300000X |
| Licence No | 19027433 |
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Definition: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: denti |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 9202327 | IL | -- |
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What is the Brenden Delaney Moon's unique identification number?
The Brenden Delaney Moon has been assigned the NPI (National Provider Identifier) Number 1730375171 by the Centers for Medicare & Medicaid Services (CMS). This 10-digit code serves as a unique identifier for the organization.
Could you please provide the complete physical location address of Brenden Delaney Moon?
The Brenden Delaney Moon is physically situated at 671 Wabash Ave, in the city of Carthage, state of IL, with the postal code 62321.
What is Brenden Delaney Moon's primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Brenden Delaney Moon is Dentist, and the taxonomy classification code that categorizes this area of expertise is 122300000X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1730375171 to Brenden Delaney Moon?
The Centers for Medicare & Medicaid Services originally issued the 1730375171 to Brenden Delaney Moon on 2007-09-19.
As of what date were the Brenden Delaney Moon's details last updated?
The information pertaining to the Brenden Delaney Moon, including its address, specialty, and other details, was most recently updated on 2011-09-07.