Individual
MR. STACY JERALD MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4266 N EAGLE RD, BOISE, ID 83713-0726
(208) 939-7053
(208) 938-6032
Mailing address
3550 N BROOKSIDE LN, BOISE, ID 83714-9705
(208) 908-1793
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3387
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
820527796
IRS
ID
Enumeration date
05/12/2006
Last updated
07/06/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us