Organization
ELLIS MOON ORTHODONTICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUDREY MOON D.D.S., M.S.D. (MANAGING MEMBER)
(281) 485-6003
Entity
Organization
Contact information
Practice address
2015 BROADWAY ST, SUITE A, PEARLAND, TX 77581-5698
(281) 485-6003
(281) 485-3376
Mailing address
2015 BROADWAY ST, SUITE A, PEARLAND, TX 77581-5698
(281) 485-6003
(281) 485-3376
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
15404
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
28170
TX
Other
Enumeration date
02/01/2017
Last updated
02/01/2017
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