Provider Demographics
NPI:1821125238
Name:MOON, RONALD J (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:J
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 1:3100 TIMMONS LN
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-5926
Mailing Address - Country:US
Mailing Address - Phone:713-777-6453
Mailing Address - Fax:
Practice Address - Street 1:3100 TIMMONS LN
Practice Address - Street 2:SUITE 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-5926
Practice Address - Country:US
Practice Address - Phone:713-777-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice