Organization
DR. KERRY MOON, D.D.S., PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KERY MOON DDS (OWNER DENTIST)
(501) 281-5347
Entity
Organization
Contact information
Practice address
2501 CRESTWOOD RD STE 201, NORTH LITTLE ROCK, AR 72116-7616
(501) 758-5006
Mailing address
719 WILLOW ST, NORTH LITTLE ROCK, AR 72114-4637
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
243554608
—
AR
Enumeration date
04/06/2022
Last updated
04/06/2022
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