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Organization
VISTA RIDGE DENTAL ARTS STUDIO, LLC
Active
Organization
VISTA RIDGE DENTAL ARTS STUDIO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AMY HERRON MOODY DDS (DENTIST/SOLE MBR)
(804) 979-1800
Entity
Organization
Contact information
Practice address
108 W 10TH AVE, JOHNSON CITY, TN 37604-3800
(423) 979-1800
(423) 979-1802
Mailing address
108 W 10TH AVE, JOHNSON CITY, TN 37604-3800
(423) 979-1800
(423) 979-1802
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
10324
TN
Other
Enumeration date
12/27/2017
Last updated
12/27/2017
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