Provider Demographics
NPI:1457602682
Name:MOONEY, DENNIS R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:R
Last Name:MOONEY
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 1:215 OCHLOCKONEE ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-8022
Mailing Address - Country:US
Mailing Address - Phone:850-926-7151
Mailing Address - Fax:850-926-6116
Practice Address - Street 1:215 OCHLOCKONEE ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-8022
Practice Address - Country:US
Practice Address - Phone:850-926-7151
Practice Address - Fax:850-926-6116
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0006229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL074033100Medicaid