Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN7469 | FL |
NPI | 1154481075 |
---|---|
Provider Name | William A Moon |
First Address | Bartow, FL 33830-6740 |
Second Address | Haines City, FL 33844-4325 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 26/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DN7469 | LICENSE (01) |