Provider Demographics
NPI:1902011307
Name:JIMMY JOE MOON, DDS & BARBARA SEID MOON, DDS, INC.
Entity Type:Organization
Organization Name:JIMMY JOE MOON, DDS & BARBARA SEID MOON, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-473-6677
Mailing Address - Street 1:2009 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77502-3375
Mailing Address - Country:US
Mailing Address - Phone:713-473-6677
Mailing Address - Fax:713-473-6778
Practice Address - Street 1:2009 JOHN ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77502-3375
Practice Address - Country:US
Practice Address - Phone:713-473-6677
Practice Address - Fax:713-473-6778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13002261QD0000X
TX13206261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental