Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1881645166 Individual Practitioner Male Practitioner

Dr. Stacy Jerald Moon , DDS

Dentist • Boise, ID

Professional Overview & Biography Verified Profile Summary

Dr. Stacy Moon, DDS is a registered healthcare professional specializing in Dentist in Boise, ID. Practice services are available at 4266 N EAGLE RD under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

4266 N Eagle Rd

Boise, ID 837130726

Telephone 2089397053
Fax 2089386032
Associated Practice Facility / Clinic
🏢 Zachary Taylor Dds Pllc Facility NPI 1467029736

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist in Boise, ID

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 23.0 Yrs
State Avg: 21.3 Yrs
Regional Practice Density
108 Specialists

Practicing in Boise, ID (448 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2023-07-06
Dentist Primary Specialty

NUCC Taxonomy Code: 122300000X

State License ID D3387

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Additional State Medicaid & Healthcare Payer Identifiers

Commercial Insurance / Payer ID Irs
820527796 (ID)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events
📍
Updated Practice Location July 06, 2023

Registered at 4266 N EAGLE RD, BOISE, ID 837130726 (Tel: 2089397053)

📍
Updated Business Mailing Address July 06, 2023

Registered at 3550 N BROOKSIDE LN, BOISE, ID 837149705 (Tel: 2089081793)

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍
Updated Practice Location July 08, 2007

Registered at 6019 N EAGLE ROAD, BOISE, ID 83713 (Tel: 2089397053)

📍
Updated Business Mailing Address July 08, 2007

Registered at 5431 N BACH, MERIDIAN, ID 83642 (Tel: 2088957940)

👤
Provider Name / Credentials Updated July 08, 2007

Recorded as STACY MOON, DDS

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #D3387 in ID)

🟢
Initial NPI Registration & Enumeration May 12, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1881645166
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 12, 2006
Last Update: July 06, 2023
Sole Proprietor: Yes

Mailing Address

3550 N Brookside Ln

Boise, ID 837149705

Phone: 2089081793

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.