# VISTA RIDGE DENTAL ARTS STUDIO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154837292
- **Authorized official:** DR. AMY HERRON MOODY DDS (DENTIST/SOLE MBR)
- **Authorized official phone:** (804) 979-1800

## Contact information

- **Practice address:** 108 W 10TH AVE, JOHNSON CITY, TN 37604-3800
- **Practice address phone:** (423) 979-1800
- **Practice address fax:** (423) 979-1802
- **Mailing address:** 108 W 10TH AVE, JOHNSON CITY, TN 37604-3800
- **Mailing address phone:** (423) 979-1800
- **Mailing address fax:** (423) 979-1802

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 10324 | TN | Yes |

## Other

- **Enumeration date:** 12/27/2017
- **Last updated:** 12/27/2017