Provider Demographics
NPI:1366841439
Name:MOON, ERIC S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:MOON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3972 BARRANCA PKWY STE M
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8292
Mailing Address - Country:US
Mailing Address - Phone:949-559-5900
Mailing Address - Fax:949-651-1500
Practice Address - Street 1:3972 BARRANCA PKWY STE M
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8292
Practice Address - Country:US
Practice Address - Phone:949-559-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1024021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice