Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Stacy Jerald Moon, DDS

Individual provider Dentist · NPI 1881645166

Mr. Stacy Jerald Moon, DDS is a Dentist in Boise, Idaho. Practices as a sole proprietor. Licensed in Idaho.

Licensed in
ID
In the registry since
2006
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

See every abbreviation used in this directory →

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Practice location Address checks out

4266 N Eagle Rd
Boise, ID 83713-0726
Phone: (208) 939-7053
Fax: (208) 938-6032
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D3387 (ID)

Record details

NPI number1881645166
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorYes
NPI enumeratedMay 12, 2006
Last updated in NPPESJuly 6, 2023
Certification dateJuly 6, 2023
Mailing address3550 N Brookside Ln, Boise, ID 83714-9705

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