Provider Demographics
NPI:1922345016
Name:SUE K MOON DDS PC
Entity Type:Organization
Organization Name:SUE K MOON DDS PC
Other - Org Name:CORNERSTONE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MOON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-771-3389
Mailing Address - Street 1:2 CARDINAL PARK DR SE STE 206A
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-4401
Mailing Address - Country:US
Mailing Address - Phone:703-771-3389
Mailing Address - Fax:703-771-8242
Practice Address - Street 1:2 CARDINAL PARK DR SE STE 206A
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-4401
Practice Address - Country:US
Practice Address - Phone:703-771-3389
Practice Address - Fax:703-771-8242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014103851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty