BEVERLY MOON DMD LLC (NPI# 1962037523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962037523 |
| Entity Type | Organization |
| Organization Name | BEVERLY MOON DMD LLC |
| Practice Address |
4601 W 109th St Ste 240 Overland Park KS 66211-1323 |
| Mailing Address |
16424 Lucille St Overland Park KS 66221-7032 |
| Practice Telephone | 9133383384 |
| Mailing Telephone | 7327541998 |
| Enumeration Date | 2020-03-04 |
| Last Update Date | 2020-03-04 |
| Authorized Official Name | BEVERLY MOON (DENTIST) |
| Authorized Official Telephone | 7327541998 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Street Address |
4601 W 109TH ST STE 240 |
| City | OVERLAND PARK |
| State | KS |
| Zip Code | 66211-1323 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336611821 | Baillie Rose Woydziak | Social Worker | 5805 W 110th Street, Overland Park, KS 66211 | 2018-12-20 |
| 1467920389 | Ku Medwest Ambulatory Surgery Center, LLC | Clinic/Center | 10720 Nall Avenue, Overland Park, KS 66211 | 2018-11-08 |
| 1235615931 | Janice Carollo | Physical Therapy Assistant | 11611 Granada Lane, Leawood, KS 66211 | 2018-07-16 |
| 1720572555 | Trevor Lee Elmer | Physical Therapist | 10777 Nall, 320 - Corporate Medical Plaza Building II, Overland Park, KS 66211 | 2018-06-15 |
| 1043746555 | Overland Park Surgical Suites, LLC | Clinic/Center | 6650 W 110th St Ste 300, Overland Park, KS 66211 | 2017-05-03 |
| 1619313665 | Vcphcs Xiv, LLC | Clinic/Center | 6331 W. 110th Street, Overland Park, KS 66211 | 2013-05-17 |
| 1528334950 | Scott Anthony Hardouin | Surgery | 5100 W 110th St Unit 300, Overland Park, KS 66211 | 2012-03-29 |
| 1386917003 | Children's Physical Therapy Associates | Physical Therapist | 6600 College Boulevard, Suite 307, Overland Park, KS 66211 | 2012-02-10 |
| 1871876250 | Amber Diane Dalzell | Social Worker | 10965 Granada Ln Ste 102, Overland Park, KS 66211 | 2011-09-22 |
| 1912298001 | Stephen Vincent Hiatt | Orthopaedic Surgery | 10701 Nall Avenue, Suite 200, Overland Park, KS 66211 | 2011-04-25 |
| Find all providers in zip 66211 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760018576 | Senior Dental Care of Ms, LLC | Clinic/Center | 8500 W 110th St Ste 450, Overland Park, KS 66210-4029 | 2020-03-13 |
| 1568976041 | Rc Rhoads Dental, Pa | Clinic/Center | 6700 W 121st St Ste 101, Overland Park, KS 66209-2028 | 2017-11-20 |
| 1861872475 | Dental Partners of Overland Park LLP | Clinic/Center | 8700 Santa Fe Dr, Overland Park, KS 66212-3654 | 2015-06-09 |
| 1972080588 | Genmat Op, Pa | Clinic/Center | 11016 Quivira Rd, Overland Park, KS 66210-1239 | 2018-07-26 |
| 1609395342 | Wheat State Dental of Overland Park LLC | Clinic/Center | 9601 Antioch Rd, Overland Park, KS 66212-4061 | 2017-09-13 |
| 1043699853 | Kathryn N Stanley Dds Chartered | Clinic/Center | 8575 W 110th St, Suite 110, Overland Park, KS 66210-1868 | 2015-05-26 |
| 1457671810 | Matthew T. Lenz Dds, LLC | Clinic/Center | 14221 Metcalf Ave, Suite 100, Overland Park, KS 66223-3367 | 2010-06-08 |
| 1558526616 | Apex Endodontics, Pa | Clinic/Center | 13340 Metcalf Ave, Overland Park, KS 66213-2804 | 2008-07-28 |
| 1568632206 | William H. Doyle,d.d.s.,p.a. | Clinic/Center | 5370 College Blvd, Suite 120, Overland Park, KS 66211-1621 | 2008-03-10 |
| 1255522330 | Tull Oral and Facial Surgery | Clinic/Center | 12541 Foster St, Suite 330, Overland Park, KS 66213-2630 | 2007-08-05 |
| Find all providers in OVERLAND PARK | ||||
| City | OVERLAND PARK |
| Zip Code | 66211 |
Please comment or provide details below to improve the information on BEVERLY MOON DMD LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.