# MOODY DENTAL LLC

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

## Provider details

- **NPI number:** 1396110508
- **Authorized official:** DR. MOODY WASIF D.M.D (DENTIST/OWNER)
- **Authorized official phone:** (219) 322-6892

## Contact information

- **Practice address:** 13955 MORSE ST, CEDAR LAKE, IN 46303-9639
- **Practice address phone:** (219) 374-5591
- **Practice address fax:** (219) 374-5592
- **Mailing address:** 13955 MORSE ST, CEDAR LAKE, IN 46303-9639
- **Mailing address phone:** (219) 374-5591
- **Mailing address fax:** (219) 374-5592

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12011396A | IN | Yes |

## Other

- **Enumeration date:** 12/14/2015
- **Last updated:** 12/14/2015