Individual
DR. BRENDEN DELANEY MOON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
671 WABASH AVE, CARTHAGE, IL 62321
(217) 357-2171
(217) 357-3562
Mailing address
671 WABASH AVE, PO BOX 357, CARTHAGE, IL 62321
(217) 357-2171
(217) 357-3562
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019027433
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9202327
—
IL
Enumeration date
09/19/2007
Last updated
09/07/2011
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