NPI age
20 years
Enumerated 2006-05-12
● Active
Type 1 · Individual
MR. Stacy Jerald Moon, DDS
Moon is 1 of 143 dentist providers in Boise and 1 of 591 in Idaho.
Primary specialty
Dentist
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2023-07-06
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 591 active dentist providers in Idaho.
NPI age
20 years
↑ 4 yr above median (16 yr)
State licenses
1 state
11% of peers hold multiple states
Subspecialties
0
17% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-05Enumerated in NPPES
2006
2026
Where they practice
Practice location
4266 N Eagle Rd
Boise, ID 837130726
Mailing address
3550 N Brookside Ln
Boise, ID 837149705
Specialties
-
Dentist PrimaryA 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...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 (ID) | 820527796 | IRS |
Practice context
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.