Moon, Stacy Jerald
Moon, Stacy Jerald is an sole proprietor health care provider with primary practice located at 4266 N Eagle Rd , Boise ID 83713-0726. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Moon, Stacy Jerald can be contacted via phone (208) 939-7053.Contact Information
Primary practice address
4266 N Eagle Rd
Boise ID 83713-0726
Phone: (208) 939-7053
Fax: (208) 938-6032
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | D3387 | Idaho |
Profile Details
| NPI number | 1881645166 |
|---|---|
| LBN Legal business name | Moon, Stacy Jerald |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 12th, 2006 |
| Last updated | Jul 6th, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881645166 | NPPES |
| Idaho | Other | 820527796 | IRS |
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