PAMELA D MOON (NPI# 1972991552) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972991552 |
| Entity Type | Individual |
| Full Name | PAMELA D MOON |
| Practice Address |
6600 Lyndale Ave S 132 Richfield MN 55423-3380 |
| Mailing Address |
6625 Lyndale Ave S Suite 300 Richfield MN 55423-2373 |
| Practice Telephone | 6122438999 |
| Mailing Telephone | 6122438999 |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2015-01-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 125J00000X | Dental Therapist | DT16 | MN | Dental Providers |
| Street Address |
6600 LYNDALE AVE S 132 |
| City | RICHFIELD |
| State | MN |
| Zip Code | 55423-3380 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689655722 | Michael B Debrule | Podiatrist | 6600 Lyndale Ave S, Suite#130, Richfield, MN 55423-3380 | 2005-11-07 |
| 1336507417 | Curantis Hhc LLC | Home Health | 6600 Lyndale Ave S, Suite 110, Richfield, MN 55423-3380 | 2016-02-04 |
| 1659759082 | Brent James Larson | Podiatrist | 6600 Lyndale Ave S, Richfield, MN 55423-3380 | 2015-05-18 |
| 1013263821 | Midwest Podiatry Centers Pllc | Podiatrist | 6600 Lyndale Ave S, Suite 150, Richfield, MN 55423-3380 | 2012-07-30 |
| 1437478666 | Midwest Foot & Ankle Specialists, LLC | Podiatrist | 6600 Lyndale Ave S, Suite 130, Richfield, MN 55423-3380 | 2010-05-27 |
| 1144471475 | Farrell Soron Stiegler | Surgery | 6600 Lyndale Ave S, 205, Richfield, MN 55423-3380 | 2008-10-06 |
| 1518177575 | Onsite Podiatry, Inc. | Podiatrist | 6600 Lyndale Ave S, Suite 130, Richfield, MN 55423-3380 | 2007-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841844081 | Ann Niebuhr | Counselor | 6417 Penn Ave S Ste 8 #2, Minneapolis, MN 55423 | 2019-07-25 |
| 1073021077 | Alton John Olson | Surgery | 7008 - Morgan Avenue South, Richfield, MN 55423 | 2018-01-12 |
| 1992238190 | Certified Care Planner LLC | Home Health | 1515 E 66th Street Suite 105, Richfield, MN 55423 | 2017-04-05 |
| 1245780121 | Rachel Lauren Marston | Audiologist | 7745 2nd Ave S., Suite 1, Richfield, MN 55423 | 2016-10-04 |
| 1023564093 | Justine Welch Mastin | Counselor | 6640 Lyndale Ave S Ste 110, Minneapolis, MN 55423 | 2016-08-30 |
| 1215480942 | Smart Choice Mri, LLC | Clinic/Center | 1704 E 66th St, Minneapolis, MN 55423 | 2016-07-29 |
| 1225425531 | Maria Lourdes Nolasco De Leon | Registered Nurse | 6511 12th Ave. S, Richfield, MN 55423 | 2015-04-24 |
| 1508261926 | Ally Medical Supply | Durable Medical Equipment & Medical Supplies | 6238 Lyndale Ave South, Suite # 2, Richfield, MN 55423 | 2014-10-28 |
| 1811230097 | Barb Rose Olson | Registered Nurse | 6461 Lyndale Ave. So, Richfield, MN 55423 | 2013-04-05 |
| 1902149404 | Nina Kae Hanevik | Registered Nurse | 6461 Lyndale Ave So, Richfield, MN 55423 | 2013-04-03 |
| Find all providers in zip 55423 | ||||
| Taxonomy Code | 125J00000X |
| Grouping | Dental Providers |
| Classification | Dental Therapist |
| A Dental Therapist is an individual who has completed an accredited or non-accredited dental therapy program and who has been authorized by the relevant state board or a tribal entity to provide services within the scope of their practice under the supervision of a dentist. Functions that may be delegated to the dental therapist vary based on the needs of the dentist, the educational preparation of the dental therapist and state dental practice acts and regulations. |
| Notes: Source: Summarized from Minnesota Statute 150A.105. [7/1/2012: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851800429 | Theresa Marie Aymond | Dental Therapist | 6601 Lyndale Ave S Ste 230, Richfield, MN 55423-2479 | 2017-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487264446 | Amber Nichelle Irby | Dental Therapist | 903 W Center St #130, Rochester, MN 55902 | 2020-08-05 |
| 1558835942 | Jennifer Iacobelli | Dental Therapist | 13899 Highway 13 South Frontage Road, Savage, MN 55378 | 2019-01-18 |
| 1992288781 | Katie Ask | Dental Therapist | 13889 Highway 13 S, Frontage Rd, Savage, MN 55378 | 2018-09-08 |
| 1487154092 | Sunny Moon | Dental Therapist | 10584 France Ave S, Bloomington, MN 55431-3538 | 2018-02-20 |
| 1326548454 | Julie Bonham | Dental Therapist | 803 3rd St. Se, Suite 330, Little Falls, MN 56345 | 2018-02-15 |
| 1376077974 | Saritha Gajawada | Dental Therapist | 15354 Plumstone Dr, Eden Prairie, MN 55347-2061 | 2017-04-20 |
| 1649644063 | Brittany Gronland | Dental Therapist | 25730 Smithtown Rd, Excelsior, MN 55331-8592 | 2015-11-23 |
| 1124405857 | Jenna Susanne Marquardt | Dental Therapist | 209 South 1st Street, Montevideo, MN 56265 | 2015-05-01 |
| 1558751495 | Weston Mark Schmidt | Dental Therapist | 411 East Howard St., Jacobson Family Dentistry PC, Hibbing, MN 55746 | 2015-01-30 |
| 1003230137 | Janelle Jehn | Dental Therapist | 4342 4th Ave S, Minneapolis, MN 55409-2155 | 2014-02-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.