Provider Demographics
NPI:1881299519
Name:MOON & GO, DDS, INC
Entity type:Organization
Organization Name:MOON & GO, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:JEONG
Authorized Official - Middle Name:CHUL
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-294-8551
Mailing Address - Street 1:599 INLAND CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-1819
Mailing Address - Country:US
Mailing Address - Phone:909-383-1600
Mailing Address - Fax:909-383-1616
Practice Address - Street 1:599 INLAND CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-1819
Practice Address - Country:US
Practice Address - Phone:909-383-1600
Practice Address - Fax:909-383-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty