Provider Demographics
NPI:1235364696
Name:MOONEY FAMILY & COSMETIC DENTISTRY, PLLC
Entity Type:Organization
Organization Name:MOONEY FAMILY & COSMETIC DENTISTRY, PLLC
Other - Org Name:MOONEY FAMILY DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-639-0737
Mailing Address - Street 1:23535 W IH 10
Mailing Address - Street 2:SUITE 2202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1668
Mailing Address - Country:US
Mailing Address - Phone:210-687-1444
Mailing Address - Fax:210-687-1445
Practice Address - Street 1:23535 W IH 10
Practice Address - Street 2:SUITE 2202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1668
Practice Address - Country:US
Practice Address - Phone:210-687-1444
Practice Address - Fax:210-687-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty