Organization
BEVERLY MOON DMD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEVERLY MOON DMD (DENTIST)
(732) 754-1998
Entity
Organization
Contact information
Practice address
4601 W 109TH ST STE 240, OVERLAND PARK, KS 66211-1323
(913) 338-3384
Mailing address
16424 LUCILLE ST, OVERLAND PARK, KS 66221-7032
(732) 754-1998
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
03/04/2020
Last updated
03/04/2020
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