Provider Demographics
NPI:1063761773
Name:THOMAS F. MOONEY, III, DDS, MDS, LLC
Entity type:Organization
Organization Name:THOMAS F. MOONEY, III, DDS, MDS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER / MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MOONEY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:636-970-4700
Mailing Address - Street 1:9018 PHOENIX PKWY
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-4278
Mailing Address - Country:US
Mailing Address - Phone:636-970-4700
Mailing Address - Fax:
Practice Address - Street 1:9018 PHOENIX PKWY
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4278
Practice Address - Country:US
Practice Address - Phone:636-970-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015486261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental