Beverly Moon Dmd LLC
Clinic/Center, Dental in Overland Park, KS. Organization (NPI-2).
NPI number1962037523
StatusActive
Last updated in NPPESMar 4, 2020
Details
- NPI
- 1962037523
- Entity type
- Organization (NPI-2)
- Legal business name
- Beverly Moon Dmd LLC
- Organization subpart
- No
- Enumeration date
- Mar 4, 2020
- Certification date
- Mar 4, 2020
- Last updated
- Mar 4, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QD0000X | Clinic/Center, Dental | – | – | Yes |
Practice location
4601 W 109th St Ste 240Overland Park, KS 66211-1323
Phone 913-338-3384
Mailing address
16424 Lucille StOverland Park, KS 66221-7032
Phone 732-754-1998
Authorized official
Beverly Moon
Dentist
7327541998
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